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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />OS Water supply dispenser with warm water at a minimum of 100° F (i.e. 5-20 gallon container with spigot). <br />S3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Important** <br />Completed by: 14. <br />Health Permit <br />PHpBr Hand Towels <br />Soap dlsponser <br />Cullino Board <br />BleachPrvpano Stove <br />Fire Extinqulsher <br />Ice Cooler <br />ILMP LVENT APP <br />E 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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slemo w/Chafflng <br />□ish <br />Extra <br />Watar <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Garbage <br />Can <br />(>/• -rti.•. •.*. > 'i t •. <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 below41°F temperature): <br />[$ Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />SAN JOAQUIN <br />COUNTY <br />Title <br />Rinse Water <br />Propane Tank <br />1868 E. Hazelton Avenue | Stockton, California 95205 I T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />_ n r a 4 Tr~a«fi i »rr“kit aiEHD 16 02 Page 6 of 11 <br />06/19/19 <br />i <br />Soap and Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />'faetky C, _______________________ <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 /> <br />Si^aturq/^ Title Date <br />5-20 Gai. <br />Hann wash Water <br />o^□1 <br />Extra ten Sags 3 Food Contofnors must ba | <br />stored 5 inches off of lha ground! |