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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 />13. <br />“Important** <br />14.Completed by: Owner <br />Signature Title Date <br />Health Permit <br />Pape* Hand TovmK <br />Soap dispenw* <br />CutMxj Board <br />Propane Store <br />Propane Tank <br />Beach and Water <br />Pro Edmqusharfl <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <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 />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />Ktion (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 />Stomo wlChaffing <br />Osh <br />Exva <br />Water <br />5 Gai Hand wash <br />WMtowater Contanor <br />5-20 Gal <br />Hand wash Waler <br />Sarwuzor bucket- <br />bieach 4 water lor <br />storing wiping ctochs <br /> Booth must be on <br /> Concrete. Asphalt. <br />Plywood, ora Tarp. <br />Garbage <br />Can <br />SAN JOAQUIN <br />— COUNTY------ <br />L/J One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_ y • x ,r i ____________________________________________________________________________________ <br />J <br />Soap and Waler <br />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 />^^Ice chests ^g^efrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />7 <br />Rinse Waiar <br />Eulra ice Bays 4 Food C<x>fa»»ers 'nusZ be | <br />Uored 6 mcfiex olfo/tne 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 festival coordinator three weeks prior to <br />this event 7/ / J /y