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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Propane Slovo Bleach <br />I I j1—r(Propane Tank <br />Bleach and Water <br />Fire Extinguishera <br />Extra Ice Bags 4 Food Containers must bo <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />Garbage <br />Can <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 />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Conlainer <br />5-20 Gal. <br />Hand wash Waler <br />/Uu n 6'7-. <br />SAN JOAQUIN <br />.1 ------COUNTY------- <br />,r.op»‘'' Greotness grows here. <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 />0 Ice chests 0 Refrigerator <br />□ Refrigerated truck 0 Ice bath and tubs <br />□ Other (specify)_____________ <br />E Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One <br />. . . If <br />Important** <br />z_ <br />Rinse Water <br />Ice Cooler <br />___________/ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <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 />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 0 of 11 TEMP EVENT APP <br />06/19/19 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Names of responsible persons to be present in booth during all hours of operation: <br />r-Q-VMDvQ Gi)i?'l£viqf ■ ItA/lvTO L- <br />**,wr'''•*'—'*** 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 />Jthis event. 2/ <br />1 / r- c f J____________________________07 /T-xhj <br />Signature Title Date