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SAN JOAQUIN 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 />® One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />® Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />**lmportant** <br />Completed by: 14. <br />Signature Title Date <br />Paper Hand Towels <br />Soap dispenser <br />BlenchPropane Stove <br />I <br />Propano Tank <br />Bloach and Water <br />Piro I xtingulshor <br />’ Ice Cooler I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ico Bags A Food Containers must bo <br />storod 6 Inches off of tho ground! <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 />Stomo w/Chaffing <br />Dish <br />Lxlra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />b-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach A water tor <br />storing wiping cloths <br />Booth must bo on <br />Concrete, Asphalt, <br />Plywood, or a larp. <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 /> Other (specify) <br />Health Permit <br />Soap and Walor Rinso Water <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 of 11 TEMP EVENT APP <br />07/01/2074 <br />I am providing the 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). <br /> Tub to store wiping cloths in bleach solution. <br />Cutting Board