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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />I3 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />2^ Paper towels and pump-style soap container. <br />13. <br />14. <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BlaactiPrapeno Stova <br />I <br />Q <br />Ice Cooler <br />TEMP EVENT APPPage 0 of 11 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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). <br />0 Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Exira <br />Water <br />5 Gal Hand wash <br />Wasluwatar Container <br />Garbage <br />Can <br />Sonlllzer buckel- <br />bloacti 8 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />stemo w/Chnffing <br />Dish <br />5-20 Gal. <br />I land wash Wnlor <br />J <br />Qiv r e C <br />TitleSignature <br />Names of responsible persons to be present in booth during all hours of operation: <br />SkfiC •f'ec f S /) Jf <br />**lmportanr* <br />Propane Tank <br />I Fire Extinguisher <br />ri <br />^1 I <br />SAN JOAQUIN <br />------COUNTY------- <br />Cl.’OllIi'SS i/Ml'.VS <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 />0 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)________________________________________________________ <br />p.iti'.1,' <br />' ) • ! • <br />Soap and Water <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />El )D 16.02 Page a of 11 TEMP EVENT <br />GllZIVf <br />iponsible persons to be present in booth during a.. ■~ ,. <br /> <br />l/fcfcrfS /)t-ur^vx(A/illfAms ______________________________ <br />All food venior 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 evenf. a x „ r-' <br />Completed by: Qiv r\ g J I p <br />Date <br />| Health Permit <br />Exira Ice Bags & Eood Contolncn must bo d <br />stored 6 filches off of Ihe ground! I