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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />**!mportant** <br />14.Completed by: <br />1 Pupnr I land Towels <br />Soup difiponsar <br />Cuffing Board <br />Propono 8lovo <br /> L; ‘?LPropsnu Tank <br />Hro ExBnflUtBhor <br />Ice Cooler <br />TEMP EVENT APP <br />Health Permit <br />4xTu,.’?'. ■ <br />£dra Ice Bags & Food ConUdnern musl bo <br />siomd 3 Idcbesolfof thBgroundl <br />Star no wfCtiaJiing <br />Dish <br />5 Gal Hand wash <br />WostewaiEr ConWncr <br />5-20 Gnl. <br />Hand wash Wator <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Skater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot}. <br />SaniHziw bucket- <br />branch & waler for <br />stcrino wiplf»D cloths <br />\.___^-'Si<jnaturo <br />( Extra \ <br />Wnior <br />Names of responsible pe^^e^^^res^^^otli <br />[jfOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />O^aper towels and pump-style soap container. <br />3 <br />Soap nnd Wnior <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 - PaQO 8 of 11 ’m?/? r.'cr.T.*.: <br />06/19/19 <br />? A SANJOAQUIN <br />“ AA -----COUNTY— <br />• rra-c; Urcatness grows here. <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45>c (if food is used the following day, maintain below 410F temperature): <br />0lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)______________ <br />Rlnoo Water <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />®Ahree 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 />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 ail hours of <br />preparation andjapgratton. Return original to festival coordinator three weeks prior to <br />this <br /> <br />Title Date <br />I Bleach