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Environmental Health Department <br />12.borthPrOV'dln9 the followin9 for adecluafe hand washing facilities, but separate from utensil wash within my <br />'aper towels and purnp-style soap container. <br />13. <br />“Important”* <br />14. Completed by: <br />ignaturo <br />Health Permit <br />PuporManclTomito <br />Cuulna Boon! <br />Prop.iiw Slovo <br />Propen, Tank <br />Dlooch and Water <br />Flru <br />Pago 0 0(11 <br />5 Gal Hand wash <br />Wustewalur Contelnor <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />i/ater supply dispenser with warm water at a minimum of 100°F (i.e, 5-20 gallon container with spigot), <br />•ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Sterno WChaMng <br />IJI»h <br />Garbo ge <br />Can <br />SanWzor bucKa:. <br />Waoch & wnioz for <br />Bering wi(Jng cloths[ Btoach <br />f=4Ice Cooler <br />Names of responsible o^eration^ <br />11. I_arn providing thejollowlng Items within my booth for the sanitary cleaning of food preparation utensil <br />OR 0 ' <br />5-20 Gnl <br />r- Hsnd wash Water <br />| Soup dUnonaar | \ <br />Etfra fco Sova i Food CoMntut musl bo <br />sterad fl tncMsotfoltiiagrourxil <br /> Three compartment sink. <br />©<hree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and on© 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. <br />All food vendor booths are subject to inspection. Please make a copy of this application In <br />preparation for tills event A copy of Uiis checklist must be In the booth at all hours of <br />preparation andjjpgratfon. Return original to festival coordinator three weeks prior to <br />this evenL^ Z ~~~/ T-------- <br />Tide Date <br />™^2Hazen°nAvenuel Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />05/19/18 Pago a 0(11 TEMP EVENT APR <br />.ja'xa- <br />Sospnnd Wrier Rtrajo Water <br />SAIWOAQUIN <br />i ~ '------COUNTY------ <br />'' 'a?--. ’ Greatness grows here. <br />10- <br />0Uce chests □Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify)___________