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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />vETWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutbng Board <br />BleadiPropane Stove <br />It <br />Bleach and Water <br />Fuc Extinguishera <br />Ice Cooler <br />Scanned with CamScanner <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Ertra Ice Baja & Food Cotilainara must bo <br />alaed fl inches oH d tho giound' <br />Garbage <br />Can <br />Stemo w/Chaflng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Santizer bucket- bleach & water lot <br />■tonng waping doth* <br />Propane Tank <br />••Important** <br />1868 E Hazelton Avenue | Stockton California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 1602 Pago 8 of 11 TEMP EVENT APP <br />06/19/19 <br />S20 Gal <br />-----------------'Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following items wlhin my booth for the sanitary cleaning of food preparation utensil <br />\07hree compartment sink. <br /> Three deep tubs (basins 6-S inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation. <br />n kfryi_________________________________________ _______ <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 operation. Return original to festival coordinator three weeks prior to <br />this event. <br />_________ _________________Haimmo_____ <br />Signature Title 0 <br />SAN JOAQUIN <br />COUNIY <br />G'*ntnrt< grown <br />I am providing the foltowing cold temperature control for the cold hoWng of potentially hazardous foods below <br />45T (H food is used the foltowing day, maintain betow 4IT temperature) <br /> Ice chests vQ^Refrigerator <br />>0’Refr1gerated truck Q Ice bath and tubs <br />Other (specify) _______ ___________________________________ <br />7/7 <br />Soap and Waler Rinse WMer