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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by:14. <br />ate <br />Health Permit <br />Paper Hana Towels <br />Soap disoensar <br />Cutting Board <br />Propane Stove Bl aach <br />0Ju <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />Titlegnature <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Stemo w/ChaffingDish <br />Extra <br />Water <br />Sanitizer bucket- <br />Oleacn 4 water for <br />storing wiping doths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Water <br />SAN JOAOUIN <br />COUNTY <br />z <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19 <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 />thjs even <br />^Important** <br />' S ii uJ±h '"r91/0"1 ‘‘’T^ “T01 f°r the COld h0ldin9 of P°tential|y hazardous foods below <br />45 F (if food IS used the following day, maintain below 41 °F temperature): <br />Ice chests Q Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify)____ ___________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />1 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 />qy Tub to store wiping cloths in bleach solution. <br />Extra Ice Sags i Food Containers must be I <br />stored 6 Inches off of the ground! ; <br />'p 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 />Tp. Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: 7