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.(..cpiv <br />Environmenta! Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by. <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cultinfl Board <br />1 Propane Stove <br />f <br />Rinse Water Bleach nnd Waler <br />Fire Extinguisher <br />Page 8 of 11 <br />a Extra <br />Waier <br />Garbage <br />Can <br />Sanitizer ducket­ <br />bleach & water tor <br />storing wiping cloths <br />Booth must be on <br /> Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Slemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />Ice Cooler 1 ] <br />Title <br />’g[ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />J^r-One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />| Bleach <br />Propane Tank <br />II" <br />□nThree conip^art^^ within my booth for the sanitary cleaning of food preparation utensil <br />SluUo^one^btespoon^fbli^^r^aTon^fwater)16 Wa,er' "h51"9 3 <br /> Detergent, bleach, and wiping cloths (cleaning towels) <br /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br /> <br />^Important** <br />UlEif: . n ? <br />Exira les Bogs & Food Containers must bo a <br />stored 6 inchos otl ot tho ground! H <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sigov orq/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/10/19 <br />lam providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: J <br />./^SANJOAOUIN <br />-—COUNTY— <br />Greqtfless .grows here. <br />' Z-Ffif food iTused^foSnn 7era,Ure,COT°l for the COld h0,tJina of P°,entia"y hszard°us foods below <br />r (it tooo IS used the following day, maintain below 41°F temperature): <br />Q Ice chests Q Refrigerator <br /> Refrigerated truck Q |Ce 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 /> <br />./Signature <br />Igrr