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Environmental! Heaflth Department <br />10. <br />11. <br />OR <br />/A <br />12; •• <br />13. <br />14. <br />Paper Hand Towels <br />Soap dispenser <br />BloacliPropane Stove <br />Blaafli and Waler <br />Ice Cooler <br />TKMP EVENT APPPage Oof 11 <br />extra <br />Water <br />fi Gat Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanlllzorbuckol- <br />blondi a water (or <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Ge). <br />Hand wash Waler <br /><1 <br />Bt/ra /co I/ags S food ConM'ners must bo <br />slortxl 0 Indios oil ol Iho giouncll J <br />Rblto Waler <br />SANJOAOUIN <br />-----COUNTY------- <br />•'-■Ir.d G/T.'<)l|M'S5 l/ICHVS Iicic. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 °F temperature): <br />fi^lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)______________________________________1------ - <br /><?'/! I <br />J'; i . <br />**lmportant** <br />| f’rapono Tank <br />Health Permit J <br />I am providing (he following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 /> Detergent, bleach, and wiping cloths (cleaning towels). 'I' (/1> <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 />Stoma w/ChaHing <br />Dish <br />Soap and Walor j <br />b/| Water supply dispenser with warm water al a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />^1 One separate tub (bucket or basin) for the collection of rinse/wastewater. . . . <br /> Paper towels and pump-style soap container. <br />Names of resj^sibj^ personate be p^^nHj/booth during all hours of operation: <br /> <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/origlnal to festival coordinator three weeks prior to <br />Completed by: fi C>//6/ <br />Signature / Title Date <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wvAV.sjcohd.com <br />EHD16.O2 Page 0 6(11 TEMP EVEN! <br />07/3/17 <br />fit 1 Fire Extinguisherrrr