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tai Health DepartmentEnvironm <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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Title Date <br />Health Permit <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />tr <br />Propar* Tank <br />Bleach and Water <br />Pre Extinguisher <br />Ice Cooler <br />TEMP EVENT APR <br />Extra <br />Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags i Food Container* mutt be <br />ttored B inches ctTolIhe ground1 <br />Stemo w/Chrfing <br />Dish <br />Booth must be o <br />Concrete, Aspha <br />Plywood, or a Ta <br />5 Gal Hand wash <br />Wastewater Contatoer <br />5-20 Gai <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />____L <br />Soap and Water <br />L__ <br />Rmsa 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 prior to <br /> <br />\ Signature <br />SAN JOAO' :n <br />' -----COUNTY------ <br />Greatness 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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify). <br />"Important** <br />I Paper Hand Towels <br />Garbage <br />Can <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd_ 1 _ -min cx/ruT aiEHD 16-02 Page 8 of 11 ----- ----------- <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil 0 I $ <br /> Three compartment sink. ( " pK- <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 /> Tub to store wiping cloths in bleach solution.