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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />’''signature <br />Paper Hand Towels <br />BleacJiPropane Sieve <br />Blrn ch and Water <br />Fire Exflnguishet <br />Ice Cooler <br />£^4 <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 />5 Gel Hand woih <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Extra <br />Waler <br />Sonlttxer truexet- <br />b^aeh & walar (or <br />storing wTfiiog deCis <br />Stemo vaChaffing <br />Otsh <br />SAN JOAQUIN <br />COUNTY <br />(j' i'.'it s s liere. <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 />i^Tce chests ^J&Refirigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__________________________________ <br />I Propane Tank <br />/ <br />_z <br />Soap and Waler <br />ri <br />Rfnso Waler <br />Extra Ice Ba<p & Food Contaloors mxl be L.| <br />stored 6 inches oh ol the ground! | <br />^S^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 />5-20 Ga). <br />Y" Hand wash Waler <br />I Soap dispenser I — \ <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 />06/19/19 <br />'^^Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />^3 One separate tub (bucket or basin) for the collection of dnse/wastewater. <br />^3 Paper towels and pump-style soap container. <br />Names oLresponsible persons to be present in booth durlnoall hours of operation; / <br /> <br /> <br />••Important** 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 />Title Date <br />I CdltWKl Board <br />Health Permit J '