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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14. <br />Papor Hand Towfls <br />Cutting Owrd i (JktacltPcopano Stove <br />n <br />Prcp.mnTnnk <br />Bleach and Water <br />Fire ExltngulslierA <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <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 />Q Tub to store wiping cloths in bleach solution. <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />SJhroo compartment sink. <br />Slemo vz/Chalfing <br />DWi <br />Garbage <br />Can <br />Sanitizer buckot- <br />bloach ft waler tor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Taip. <br />5 Goll land wash <br />W.islewaler Conlalner <br />/ Exira \ <br />Water <br />SAN JOAQUIN <br />-COUNTY-- <br />(..i.'.itni .i /i< i,. <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 />El Refrigerated truck 0 Ice bath and tubs <br />□ Other (specify)__________________________________________________ <br />p.-rZ, '«■' r-gr- ' <br />Health Permit <br />/ <br />Hinso Walar <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EIID 16-02 Pa0° 0 of 11 TEMP EVENT <br />07/.V17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />^EWater 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 />5-20 GbI. <br />t— Hand wash Wnlor <br />Soap duponscr ----------- \ <br />I' <br />Extia /co dags & Food Corpsmen mail bo <br />stored 6 inches oil ollbogioimil <br />____ <br />Soap and Water 11 <br />Names of res^onsi^e persojis to bepresent in bc^olhjijiring ^houreofy eratior^, | <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 />Completed 7 <br />Ultte Date <br />1