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Environmental Health Department <br />10. <br /> Three compartment sink. <br />12. <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 />Date <br />Health Permit <br />Paper Hand Terre's <br />Soap dispenser <br />Ciitinfi Board <br />Bleach <br />Propane Stove <br />Fire Extinguisher <br />Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 of 11 TEMP EVENTAPP <br />/ <br />Rinse Water <br />1868 E. Hazelton Avenue | <br />EHD 16-02 <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br /> Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Ice Cooler J <br />______L <br />Soap and Water <br />Title <br />\ <br />Bleach and Water <br />Propane Tank <br />g <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 event > A n <br />______ _____________________ <br />Signature <br />■ T-- % <br />i.. • < <br />“Important** <br />Extra Ice Bags 6 Food Containers must be <br />stored 6 inches off of the groundl <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: Al i -Ford ‘ s pactat^ed <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Names of responsible persons to be present in booth during all hours of operation: <br />SANJOAOUIN <br />------COUNTY------ <br />Greatness grows here. <br />' ^°"ow’n9 cold temperature control for the cold holding of potentially hazardous foods below <br />(if food is used the following day, maintain below 41°F temperature): <br />0 Ice chests □Refrigerator <br /> Refrigerated truck bath and tubs <br /> Other (specify) <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />U 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 /> Tub to store wiping cloths in bleach solution.