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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Title DateSignature <br />| Health Permit <br />Paper Hand Towels <br />Soap dispenser JCutting Board <br />BreachPropane Stove <br />Propane Tank <br />Bleach and WaterSoap and Water <br />F:re Extinguisher <br />Q <br />Ice Cooler <br />TEMP EVENT APP <br />Exira Ice Bags <5 Food Containers must be <br />stored 6 inches off o! the ground'. <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp <br />£^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <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 />[jjkrhree compartment sink. <br />Stemo w/ChafSng <br />Dish <br />Exsa <br />Waler <br />5-20 Gal. <br />Hand wash Water <br />SANJOAOUIN <br />------COUNTY------- <br />Greotness grows here. <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 /> Refrigerated truck Ice bath and tubs <br /> Other (specify)---------------------------------------------------------------------------------------------------------------------------- <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVE? <br />07/3/17 <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 />EbDetergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />‘’Important** <br />[^Water 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 />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. <br />3- ~r: % <br />10. <br />J / \______________ <br />Rinse Water