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Environmental Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />5-20 gallon container with spigot). <br />13. <br />"Important’ <br />Completed by:14. <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board rBleach <br />Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />j Health Permit - <br />/ <br />Rinse Water <br />Extra <br />Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterna w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucxet- <br />bieach & water for <br />storing wiping cloths <br />SAN JOAQUIN <br />-COUNTY <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />gj Three compartment sink. <br />s w w <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />I | Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash wnnin my <br />booth: <br />[yfwater supply dispenser with warm water at a minimum of 100 F (i.e. <br />gfone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Propane Tank <br />3 <br />Q^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br />Garbage <br />Can <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 foilowing day, maintain below 41 °F temperature): <br />[Tj Ice chests □"’Refrigerator <br />□ Refrigerated truck Qlce bath and tubs <br />□ Other (specify) — ------------------------ -— ------— <br />| Propane Stove <br />j_____________ _ <br />5-2.0 Gal. <br />Hand wash Water <br />I _____________ <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 evont^^___________Lwnyp.' efts?* ?41 <br />Title Date <br />Extra Ice Bags & Food Containers must be <br />slored 6 inches off of the ground! J <br />1868 E Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19 <br />OliJl <br />Bleach and Wafer