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Environmenti Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />13. <br />“Important** <br />Completed by: 14. <br />7Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />IPropane Tank <br />Rinse Water Bleach and Water <br />it'Bl <br />Fire Extinguisher <br />Ice Cooler <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />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 />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />r\ 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 event. / . // ' /) - <br /> <br />Title <br />==ir <br />Soap and Water <br />SAN JOAQUin <br />-----COUNTY <br />Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous oo s e ow <br />45°F (if food is used the following day, maintain below 41 °F temperature). <br />•fpQ ice chests D Refrigerator <br />0 Refrigerated truck Ice hath and tubs <br /> Other (specify)_______________________ _______ _____________— ' <br />y"~~• <br />Garbage <br />Can <br />Extra Ice Bags & Food Containers must be 1 I <br />stored 6 inches off of the ground! (2 <br />ehd?m2 HaZelt°n Avenue ' stockt°n. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06HW19 Page 8 of 11 TEMP EVENT APR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> 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 />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: