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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Health Permit J <br />Paper Hand Towels <br />Soap dispenser <br />Gultinp Board 3Propane Stove Bloach <br />0 <br />Prooane Tank <br />Rinso Water Bleach and Water <br />Fite Fxiitiouisher <br />i Ice Cooler <br />i <br />1868 E.. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I wvvw sinov oro/ehd <br />P.9e8o(11 'TEMP EVENT APP06/29/2023 <br />1 <br />Soap and Water <br />Stcrno w/Chaffmg <br />Dish <br />Garbage <br />Can <br />Sanibzor buckot- <br />bloocli A water lor <br />storing wiping doths <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAQUIN <br />COUN ■ • <br />( Extra <br />I Waler <br />F.ttrn Ico Rags & Food Containers must bo <br />storod 6 inches oil of the ground! <br />[7] Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />__________ _JJpAi' 55^-Ll")5 --<-1 <; <br />Qjwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />® Three compartment sink. <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 />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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: <br />j persons to be present in b< <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. z-\ <br /> <br />Signature Title Date