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Environmental Health Department <br />10. <br />11. <br />OR <br />I <br />12. <br /> Water supply dispenser with warm water at a minimum of 100T (Le. 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the coltection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Health Permit <br />Pjp»r HsrtjTowtb <br />Sospdttpcrtse <br />CutfoQBotfd <br />BKMChPrcpaoe Stove <br />I <br />ftr.Tch and WalpRinse Wsbr <br />Ice Cooler j <br />PagcS of 11 Tew’ EVENT APP <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 items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gz) Hand wash <br />WssteweSr Comsns <br />Garbage <br />Can <br />ico Bsffi 4 Faotf Confaiiert mm be <br />stored 6 hcnn off of 8* grow# <br />SaniBzef budteE* <br />tMeacn & wstcr for <br />storing »&ng aoL’ts <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following odd temperature control for the cold hotting of potentially hazardous foods below <br />45SF (if food is used the following day, maintain below 41 °F temperature): <br />Effoe chests □Refrigerator <br /> Refrigerated truck 0^ce bath and tubs <br /> Other (specify) ___________________________________. ________ <br />StcmoWCtwAng <br />SAN JOAQUIN <br />------COUN'Y------ <br />rxd/jtre.— <br />Title <br />PrcpeneTtrA ________! <br />3^.^ <br />Names of responsible persons to be present in booth during all hours of operation: <br />^Important**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 />Signature <br />>20 Gat. <br />jnfTZ <br />I <br />SwpanGWBOr <br />F AreExS^Mshw <br />fin <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TTiTC.e.T.-J <br />08i73CT23 <br />j