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Environmental Heaith Department <br />10. <br />11. <br />OR <br />12. <br />Q9 Paper towels and pump-style soap container. <br />13. <br />Lirit <br />14.Completed by: <br />Signature <br />43 <br />Paper Hand Towels <br />Cutting Board 2Propane Stove Bleach <br />Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />Extra <br />Water <br />K Water supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Stemo w/Chafflng <br />Dish <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 />5-20 Gal. <br />Hand wash Water <br />0 <br />SAN JOAQUIN <br />COUNTY <br /> •f~~' .--- <br />Health Permit <br />____ __________________________.. ■.___________________________________________________ <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Title <br />Propane Tank <br />----------------------------J <br />) <br />Rinse Water <br />nun HaZGltorl AVer,iJe 1 Stocktori' California 95205 | T 209 468-3420 | F 209 464-0138 | www.siaov.org/ehd <br />Page 8 of 11 tempe^entapp <br />Garbage <br />Can <br />Names of responsible persons to be present in booth during all hours of operation- <br />_ <br />fi. AiHzy/J_______________________________________________——— <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 />^thi^^ent/ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />S.Three compartment sink. <br />Date <br />O 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 />d 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 />| Soap dispenser I <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 />H Other (specify) S