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Environmental Health Department <br />” Ult <br />10. <br />11.V <br />OR <br />12. <br />[LPWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />CU-One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />'aper towels and pump-style soap container. <br />v\y~K13. <br />"Important** <br />14.Completed by: <br />Paper Hand Tc-agIs <br />Propane Stove <br />il <br />Bleacn and Water <br />Fire ExtinguisherG <br />Ice Cooler <br />T 209 468-3420| F 209 464-0138 | <br />B of 11 <br />£ <br />1 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />E»tra ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <br />Stemo w/Chaff ng <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />reach & water for <br />storing wiping cloths <br />5-20 Gal <br />Hand wash Water <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br />i <br />; ■ <br />li <br />□ Refrigerator <br />□ Ice bath and tubs <br />\ V C/ L e / <br />Go Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp.__J <br />Soap and Water <br />IF <br />Rmse Water <br />SAN JOAQUIN <br />—COUNTY— <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 />FJ IcrTchests <br />□ Refngerated truck <br />Q-'Other (specify) (Y\\iV <br />Garbage <br />Can <br />Propane Tank <br />Health Permit <br />I Bleach <br />$ <br />ehd?^ Hazel,on Aver|ue I Stockton, California 95205 |------ <br />06/19/19 Page 8 of 11 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink <br />[FFThree 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 />Q-Betergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />w <br />i <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation fprrthis event. A copy of this checklist must be in the booth at all hours of <br />preparation, and xfperation. Return original to festival coordinator three weeks prior to <br />this event. \ / / i — j i ,------Y //—.__muvW i A ^7,3 <br />I 'Signature Title Date 1 <br />I Soap dispenser <br />I Cutting Board <br />Names of responsible persons to be present in booth during all hours of operation- C <br />_______________________________________xna; <br />Extra <br />Water