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1 ''M ')■.I.‘ //'H! <br />I <br />Environmental Health DepartmentSAN JOAOUIN <br />i <br />i <br />11. <br />4 <br />OR <br />lor soapy water, one for rinsing and one for a bleach <br />12. <br />IB Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />IB One separate tub (bucket or basin) for the collection of nnse/wastewater. <br /> Paper towels and pump-style soap container. <br />13 <br />'!14.Completed by: <br />Health Permit <br />Pnp«r Hand Towels <br />Sonr> <llsp<>nKif <br />Cumng <br />nino<:l<Propane .'Move <br />Hlmro mor <br />Fira E«linau<*l>or <br />5 <br />I <br />i <br />! <br />I <br />I <br />t <br />I <br />/ <br />I am providing tiw> following itums within my booth lor lhu sanitary cleaning of forxl preparatirxi utensil <br />f 1 1 hroe compartment sink <br />I am piovtdiih) thu toHowIng (.old lumpuiatunj ourilrol tor the ixJd holding ot palftnlinlly hazardous foods below <br />457 (if hUHl is used the following dny, malninin below 417 tnmpwalijni). <br />m loo chests O Refrlijerntor <br />'WJ Refilgeiated tmek I I Ice bath and luba <br />W Other (specify) ■, . . . _— <br />5 Gal Hand waih <br />WMlownler Container <br /> Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />I <br />J <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />StoriH) wTCtminnu <br />Dish <br />Garbage <br />Can <br />Snnittror b<rck»+- <br />Mnnch K MHrir for <br />ttortng wiping doths <br />1 <br />• ( V, <br />0 <br />Title <br />Names of responsible persons to be present in booth during all hours of operation: <br />iWa “So <br />■"Important** <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br />[J 1 hree deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />(_] Detergent, bleach, and wiping cloths (cleaning towels). <br />I ] Tub to store wiping cloths in bleach solution. <br />Propann rank <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHD 16-02 Pa9e 8 Of 11 <br />06/19/1B <br />5-20 Gal <br />y- Hand w>th WaU-r <br />1\_ <br />Date <br />__Q <br />Ice Cooler^ <br />Soap arwl Wator <br />I Extn la> Bags i. Food Contaumrs nist ba H <br />ttorad 0 nebos oltoltba ground' B <br />I ' - <br />________________ <br />> \\Q_____________________________ _____________________________________________ _ <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 wqekg prior to <br />this event. <br />Signature <br />& 10. <br />F«trn <br />Wator