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Environmental Health Department <br />10. <br />utensil Three compartment sink. <br />12. <br />13.Names of responsible persons to be present In booth during all hours of operation: <br /> <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap Dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <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 />[J^Paper towels and pump-style soap container. <br />Extra Ice Bags 4 Food Containers must be <br />stored 6 Inohes off ot the gmind! <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />Garbage <br />Can <br />Sanllfzar bucket­ <br />bleach & water for <br />storing wiping cloths <br />Stemo w/Chaffing <br />Dish <br />Datb <br />( Extra \ <br />Waler <br />Title <br />Rinse Water <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br />-------- ----------_> <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation <br /> Three compartment sink. <br />OR <br />**lmportant** <br />Propane Tank <br />SAN JOAQUIN <br />. -----COUNTY------ <br />'J'-ifo?-'"-' Great nets 5licre. <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 410F temperature): /y <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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. Return original to festival coordinator three weeks prior to <br />this eyfent <br /> <br />y Signature <br />Soap and Water <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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />[J 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: 1 <br />£ Haze,ton Avenue 1 Stockton, California 95205 I T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />oXT PaoeaofU EVENT APR <br /> <br />