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Environmental Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />13. <br />Completed by:14. <br />VHealth Permit <br />Pepor Hand TowsSs <br />Soop <Ssp®n«w <br />I CuiliMCBoanl j <br />Bleach <br />PrOfMBTO Slow <br />H <br />Propane Tank <br />Bluacn and Water <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />0 <br />Stem w/Ctrofflng <br />Oteh <br />SGafHendtvoah <br />Wastewater Container <br />&.2O Gal. <br />Hand wash Water <br />Sanitizer bucket- <br />btoachS water tor <br />EUlrtng wiping CftlthS <br />Booth must ba on <br />Concrete, AspheM <br />Plywood, or a Tarp. <br />SAN JOAOUIN <br />C. <3U M V <br />j w&tet I <br />^Important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />H Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 />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 />J3J Paper towels and pump-stvle soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br />5 <br />Garbage <br />Can <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 />(lice chests □Refrigerator <br /> Refrigerated truck !ce bath and tubs <br /> Other (specify)____--------------------------------------------------------------------------------------— <br />Extra fee Bays 4 Food Contmnsn must bo <br />sroratf s mams on a ms gmunm <br />1888 E. Hazelion Avenue | Stoekton. Celtanta 952081 T 209 488-34201 F 209 464-0138 | <br />EHD 18-02 Page 8 of 11 <br />87/3/17 <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- m __ <br />Signature Title Bat®