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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□I One separate tub (bucket or basin) for the collection of nnse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />••Important** <br />14.Completed by . <br />Health Permit <br />1 Paper Hand Towels <br />BleachPropane Stove <br />05U <br />Propane T ank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />( am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Erfra fee Bags & Food Containers must be <br />stored 6 mcties off ot the ground' <br />Sterno w/Chaffing <br />Osh <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Water <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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />P Other (specify) fcf'Xj? f <br />Sanitizer buctet- <br />bteach & water tor <br />storing wiping cloths <br />Title <br />copy of this checklist must be in the booth at aJJ hours of <br />Return original to festival coordinator three weeks prior to <br /> ■V' L. j-J <br />Date <br />SAN JOAQUIN <br />COUNTY <br />I Extra \ <br />Water <br />Rinse Watei <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 ot 11 TEMP EVENT APP <br />06/19/19 <br /> Three deep tubs (basins 6-8 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 />O Detergent, bleach, and wiping clulhs (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. <br />preparation and operation/ <br />Signature? <br />TT CI <br />Soap aid Water <br />I Soap t£ spenser | <br />Names of responsible persons to be present in booth during all hours of operation.