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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[3-Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />(3-One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />O Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by:14.Signature <br />I <br />Paper Hand Towels <br />Soap dspenser <br />Cutting Board <br />Bk'ach <br />Propane Stove <br />a <br />Propane Tank <br />Ice Cooler <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 °F temperature): <br />S Ice chests -0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />n Other (specify) ____________________________— <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & vsater for <br />stonng wp»ng doths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />0-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 />(3-Oetergent, bleach, and wiping cloths (cleaning towels). <br />S Tub to store wiping cloths in bleach solution. <br />Extra Ice Bags & Food Contasxxs must be <br />slortxi 6 tnches off of the ground! <br />5-20 Gal <br />Hand wash Water------------------— <br />Health Permit Sterno vrfChaffing <br />Dsh <br />SAN JOAQUIN <br />------COUNTY------- <br />[ Extra \ <br />Water <br />lepi <br />Title <br />ip <br />Rinse Water Garbage <br />Can <br />Soap and Water <br />Names of responsible persons to be present in booth during all hours of operation: <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 priortp <br />this event. A <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />1368 E.HszeHon Avenue | Stockton. CaWomla 95205 | T 209 468-3420 | F 209 464.0138 | www.sigo.ergM p <br />EHD 16-02 P''fl <br />06/19/19 <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp.