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Environmental Health Department <br />10. <br />11 <br />OR for soapy water, one for rinsing and one for a bleach <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100DF (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Pap«r Hand TowHs <br />CuUnnBcart <br />Propano Stove <br />11 <br />Propane Tank <br />BJeacti and Walnr <br />■ <br />Fka Ejtfnguhhar <br />Ice Cooler <br />I am providing the following items within my booth for the <br /> Three compartment sink. <br />Extra <br />Wale/ <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sle/no w/Chaffing <br />DUh <br />6 Ga( Hand wnh <br />Waxiewvler Container <br />SarAzer buckd- <br />bleadi 8 vrater for <br />■lotlng wiping dolhi <br />SAN JOAQUIN <br />COUNTY <br />Title <br />CIWI) > <br />Signature <br />I Bleach <br />sanitary cleaning of food preparation utensil <br />Names of responsible persons to be present in booth during all hours of operation: <br />VASH PAUL 5f^nA________ _____________ <br />•‘Important** <br />_z <br />Rirus Water <br /> Three deep tubs (basins 5-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping ctuUis (deatiing towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operatic^. Return original to festival coordinator three weeks prior to <br />Date <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />[""I Ice chests O Refrigerator <br /> Refrigerated truck „ Ice bath and tubs <br />0 Other (specify). <br />5-20 Gd <br />r- Hand wash W«t« <br />Soap dspenser ---------- - \ <br />rT LI <br />Soap and Waler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EHD 18-02 Page 8 of 11 TEMP EVENT APR <br />06/10/10 <br />______________________ - ■■_____________________ _________ ,, <br />Exlnlca Bogs iFoMContamen nniba | <br />ttored 6 inctvi aflo/Uia gmunal <br />- . <br />Health Permit