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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Slove <br />Bleach and Wa’.er <br />Fire Extinguisher <br />Ice Cooler <br />EHD 16-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Stemow/ChaffingDish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />( Extra \ <br />Water <br />Title <br />\. .. . ... E <br />Soap and Water <br />T. <br />Rinse Water <br />.4 <br />q-H-ZOZL/ <br />Date <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. <br />MJ " <br />10. <br />'1SANJ0AQUIN <br />f • nikc ■ •" ! ------COUNT Y— <br />Greatness yrotvs Acre. <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 />jYl Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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/p^eratioFTT Return original to festival coordinator three weeks prior to <br />Signature <br />|r <br />^Important** <br />Propane Tank <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br /> 1O1C-02 Page 0of11 TEMP EVENT APP <br />^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />j^ZOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^Paper towels and pump-style soap container. <br />Names of responsible^ersons to be present in booth during all hours of operation: <br /> <br />Extra Ice Bags & Food Containers must be |j <br />stored 6 inches off or the ground! I.. ’’ <br />/ Sanitizer buckel- <br />/ bleach & waler for <br />// ! storing wiping cloths