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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />‘‘important** <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cui Ung Board <br />Propane Stove Bleach <br />X <br />Propane T ank <br />Rinse Water Bleach and Water <br />Flro Extinguisher <br />Ice Cooler <br />EJ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />EJ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />EJ Paper towels and pump-style soap container. <br />Extra ice Bags & Food Containers must be <br />stored 6 inches off ol the Qnyjndl <br />Stemo w/Chatf ng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />Wcach a water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash WaterHealth Permit <br />Owner/operator <br />Title <br />Names of responsible persons to be present in booth during all hours of operation: <br />—Hurtngn ■■ ...... <br />:i <br />JO _ _- ... <br />7-1-26 <br />Date <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />EJ 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 />EjTub to store wiping cloths in bleach solution. <br />I^arn providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />8 Soap and Water <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. H " <br />___________ <br />Signature <br />SAN JOAQUIN <br />;?'1! Lr S! ------COUNT Y------ <br />' r. Greo (r>es s </row s here. <br />10. 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 />EJ Ice chests EJ Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />1868 E Haze'ton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />Oz/3/17 Pago 8 of 11 TEMP EVENT APP