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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />’‘Important** <br />14.Completed by: <br />Signature Title <br />Paper Hand Tow's <br />Soap a.spcnser <br />BleachPropane Stove <br />I CZZJ I <br />Propane Tank <br />Bleach and Water <br />Fire Extingu.sher <br />Page 8 of 11EHD 16-02 <br />06/19/19 <br />55 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />IS One separate tub (bucket or basin) for the collection of rinse,'wastewater. <br />Paper towels and pump-style soap container. <br />® Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />K Detergent, bleach, and wiping cloths (cleaning towels). <br />S 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 />Siomo w'Chaffing <br />Dish <br />5 Gal Hand wash <br />Waslewalof Coniainer <br />Garbage <br />Can <br />Sanftim bvckat- <br />b&acft & wate# !«• <br />storing wiping doths <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Extra /co Bags 4 Food Container's nnjst be <br />stornti 6 inches off of die ground! i. <br />Health Permit <br />SAN JOAOUIN <br />'. ------COUNTY------ <br />Greatness 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 4rF temperature): <br />jSi Ice chests [J Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify)_____ _________________________ <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 anpLppe <br />this event / <br />Ice Cooler H <br />_[) I_) D < <br />\ <br />iperation. Return original to festival coordinator three weeks prior to <br />L>4 In Im - <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />QBXt-Soap and Water Raise Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sigov.org/ehd <br />curnK.no o™ a " TEMP EVENT APP <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />■___________________________________