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SAN JOAQC'N Environmei I Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />★★I <br />14.Completed by: <br />27 Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />fl Z <br />LJ <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />l <br />1868 E. Hazelton Avenue | Stpokton. California 95205 | T 209 468-3420 1 F 209 464-0138 | mw>/.siqov.orq/ehd <br />Pag® 8 of 11 TEMP EVENT AlTEMP EVENT APP06/19/19 <br />J/ -_z <br />Soap and Water <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 />| [Paper towels and pump-style soap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />X Ice chests <br />Refrigerated truck <br />Other (specify) <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 />Refrigerator <br />X fee bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />All food vendor bb< <br />preparation for this <br />preparation arij? i <br />thisfevent. <br />>oths are subject to inspection. Please make a copy of this application in <br />> eVerit. A copy of this checklist must be in the booth at all hours of <br />operaton. Return original to festival coordinator three weeks prior to <br />/____________________ <br />Date <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />______________/ <br />Garbage <br />Can <br />Propane Tank ---------------\ <br />Names of responsible persons to be present in booth during all hours of operation: <br />fell I <br />Important*^ <br />f \□ <br />X Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />ZHLtion (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 />..‘/ML <br />■’ ■ <br />Cutting Board