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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. <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap disponsor <br />Cuttlnq Board <br />BleatflPropane Sieve <br />0■fj <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <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 />Q 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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />FMa Ice Bags a Food Containain must be <br />stored 6 Indies off ofltio 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 fostival coordinator three weeks prior to <br />this event. <br />5 Gal Hand wash <br />Waslewator Conlainor <br />Garbage <br />Can <br />Sanitizer bucket- <br />blcach a 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 cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41OF temperature): <br />Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Slerno w/Chatflng <br />Dish <br />Extra <br />Water <br />5-20 Gal <br />Hand wash Water <br />Rinse Water <br />“Important** <br />I <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 1G-02 Page 8 of 11 1EMP EVENT APP <br />06/19/19 <br />■ Ice Cooler <br />Names ofresponsible persons to be present in booth during all hours of operation: <br />