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jl <br /> <br />Environmental Health Department <br />0. <br />11. <br />OR <br />12. <br />•ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />B-Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Health Permit <br />Papet Hand Towels <br />Propane Stove <br />IRinse Walet Sleadt and Water <br />G Are Extinguisher <br />Stockton. California 95205 | T 209 468-3420 I <br />Page 8 of 11 1 F <br />IM8MS <br />_______£_ <br />Soap and Water <br />Stomow/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewaler Container <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Q^Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />( Extra \ <br />Water <br />I Soap dispenser <br /> <br />Propane Tank <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />209 464-0138 | www.sjcehd.com <br />TEMP EVENT AFP <br />’ - - » <br />—---------------— <br />Ice Cooler <br />------------------ <br />«?M!Hazelto'’ Avenue | <br />07/3/17 <br />I ampioviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />R^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 />Garbage <br />Can <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 />this event, . <br /> <br />Title Date <br />SANJOAOUIN <br />' ' --COUNTY------ <br />grows nere. z x.. .z ..... . ...7 . <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 />S^efrigerated truck Ice bath and tubs <br /> Other (specify)----------------------------- ---------------------------------------------------------------------------------—------- <br />I Culling Board <br />Names of responsible persons to be present in booth during all hours of operation: <br /> ______________