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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 />ine separate tub (bucket or basin) for the collection of rinse/wastewater <br />13 <br />"Important" <br />Completed by 14. <br />Signature <br />■ <br />Paper Hard Toweis <br /> Soap daperaer <br />C uning Eoaoj <br />Propane Stove <br />Propane Tarn <br />Rinse Water Bie ad) and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth. <br />I am providing the following cold temperalure control for the cold holding of potentially hazardous foods below <br />45"F (if food is used the following day maintain below 4 I I- temperature) <br />O Ice chests [Zl Refrigerator <br />(^Refrigerated truck Ice bath and tubs <br />O Other (specify) <br />Stemo v^Chaffing <br />Dah <br />5 Gat Hand wash <br />Wastewater Container <br />5-20 GM <br />Santkzer bucket <br />bteach & water lor <br />stemg wapaig doens <br />Extra <br />Water <br />Booth must be on <br />Concrete Asphalt <br />Plywood, or a Tarp <br />1868 E <br />EHD 16-02 <br />O6/1W19 <br />Soap and Water <br />\u/l2/2^_ <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />(A 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 />Q Tub to store wiping cloths in bleach solution <br />____________■ C. "'['-.7 <br />Extra ice Bags & Food Contaners must be <br />stored 6 inches off of the ground’ <br />Hazelton Avenue | Stockton California 95205 | T 209 468-3420, F 209 464-0138 | www sigov org/ehd <br />Page 8 of 11 TEMP EVENT APT <br />I Health Permit <br />Q \A/ f <br />Title <br />Shaper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />SAN JOAQUIN <br />_______'rfl yn, ____________________________________________ <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 operatiory-Rptum original to festival coordinator three weeks prior to <br />this event; z C. <br />Garbage <br />Can <br />L <br />i