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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />**lmportant** <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towal* <br />Soap dispenser <br />Cottlnfl Board <br />BleachPropane Stove <br />Rinse Watar <br />Are Exlrnguteher <br />Page 8 of 11 <br />Slamo w/Chaffing <br />DUh <br />5 Gal Hand wash <br />Wasta watar Container <br /> Booth must be on Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Watar <br />Garbage <br />Can <br />Extra <br />Water <br />SanlUzar bucket­ <br />bleach & waler (or <br />storing wiping cloths <br />Ice Cooler <br />SAN JOAQUIN <br />-----COUNTY------ <br />Soap and Water <br />Propane Tank <br />."W:c •ff <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, // / // . ' 1 / <br />______ ______ ________________ <br />Title Date <br />be present d^^^^Qurs of operation: <br />I Ex/ra (ca Bags £ Food Conlainars must bo ■ <br />I stomtf B Inctiot off of th» groundl S <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.orq/ehd <br />^1r?J^02 p’9° 8 0,11 TEMP event app05/ i9r 19 <br />O 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. <br />’ temPerature control for the cold holding of potentially hazardous foods below <br />45 r (it food is used the following day, maintain below 41 ‘F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />HOOther (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: 7 <br />^Vater 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 rlnse/wastewater. <br />b^k^apor towels and pump-style soap container. <br />Names of tesponslble