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Environmental Health Department <br />N& 10. <br />Nk 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 />H One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispeostr <br />BeechPropane Stove <br />Iu <br />Beach and Water <br />Fire Eriinguisher <br />Ice Cooler : <br />Page 8 of 11 TEMP EVENT APP <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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sit-mow,'Chaffing <br />Dish <br />Exira <br />5 Ga> Hand wash <br />V.'as.ewatBr Cornsner <br />Sanitizer budtet- <br />ti-zach S waler tor <br />storing wiping cioths <br />Garbage <br />Can <br />5-20 Gal. <br />Hand wash Wafer <br />SANJOAQUIN <br />------COUNTY------- <br />G 'c o r. ne5 s 9 ro ws h e re*. <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 />[S] Refrigerated truck Ice bath and tubs <br />@ Other (specify) <br />Title <br />Propane Tank ----------------! <br />Ezlra toe Bags 8 Food ContsineTs meat bo <br />stored 6 inches off of the ground! <br />Health Permit 3 <br />Names of responsible persons to be present in booth during all hours of operation: <br />M r>~ fi \ \o __________________________________________________________________________ <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 />: L / C / 3 <br />Signature Title Date <br />K\\«so <br />___v <br />**lmportant** <br />I <br />Soap and Water <br />1868 E. Hazelton Avenue I Stockton, California 95205 | I 209 468-3420 | F 209 464-0138 [ www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TZXTX <br />06/19/19 <br />I Rinse Btor <br />Booth must be on <br />Concrete, Asphalt, <br />P!ywood, ora Terp.