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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Soap and Water Rinse Water <br />Fire Extinguisher <br />Stemo w/Chaffing <br />Dish <br />5-20 Gai. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Doom must oe on <br />Concrete, Asphalt, <br /> Plywood. oraTarp- <br />Extra lea Bags A Food Conlalnarx must ba <br />siomi o mefns oCfoftne grounfl! <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <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 />Title <br />-------------------7] <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />c . J \ <br />Bleach and Water <br />Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />____________ <br />one for rinsing and one for a bleach <br />1868 E. Hazelton Avenue | Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www siaov nrn/phriPa9e8of11 ■ tempe^entapp <br />**lmportant**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" t ^2 . <br />Date <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, <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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Signature <br />• SANJOAQUIN <br />J -----COUNTY------ <br />Greatness 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 4//^ <br /> Refrigerated truck EJ Ice bath and tubs <br /> Other (specify)