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Environmental Health Department <br />10. <br />11. <br />OR <br />1Z <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 />13. <br />Completed by., 14. <br />Signature <br />Health Permit <br />Pop*.- Hand row«:i <br />Propano S-7^e <br />I <br />Bfc»cn ara Wstar <br />Ice Cooler <br />I am providing the following for adequate hand washing facifities. but separate from utensil wash within my <br />booth: <br />iraBttja I C^^ncri trust ho <br />IKrrtlB >r<r>os ct d Cv fOjntf <br />Sxemo w/CmffnQ <br />Dan <br />5 Gal Han-1 w»sn <br />HstBn'ju Contanor <br />6-2G Gal <br />lU.-a wain Water <br />Garbage <br />Can <br /> Eltra <br />Water <br />Canftror tvciop <br />Krtcti & ->at .'or <br />ilonrQ *enr>g aotfn <br />SANJOAOUIN <br />— C OU NT v — <br />Names of responsible persons to be present in booth during all hours of operation: <br />••Important*1* <br />| Pre pan* Torvit 7 <br />r<no wator <br />I CsaDCarwnMr <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a TarpI _____ <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 />J^lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ___________________ <br />- y <br />Scap «nd WaBr <br />0 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />^Jhree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sohrton (one tablespoon of bleach per gallon of water) <br />'Detergent, bleach, and wiping cloths (cleaning towels). <br />yTTub to store wiping cloths in bleach solution. <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 />Title Date ’ <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468 3420 1 F 209 464 0138 | www sjgov org/ehd <br />EHD 10-02 Page 0 of 11 TEMP EVENT AFP