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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />**tmportant** <br />14.Completed by: <br />Health Permit <br />Piper Hana Towel* <br />Soap dijpeneer <br />Cufllnq Board <br />BtaacfPropane Stove <br />Propane Tank <br />Bteacn and Wa«r <br />Flro EjlkiauU^ar <br />Ice Cooler 5 Gal Hand wash <br />Wasnrwa tor Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Water supply dispenser with warm water at a minimum of 100°F (l.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />I am provjdtng 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 />llflce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___________________________________________________________ <br />S-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sfeino w/Cha fling <br />Dish <br />Sanitiznr buckal- <br />blooch & waler for <br />wping doAs <br />Signature <br />SAN JOAQUIN <br />-----COU NTY------- <br />Na^^^fjesp^s^ble^p^raor^to be present In booth during all hours of operation: <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 />z Title <br />r-j <br />t <br />Soop «no Wauv <br />1 am providing the foflowing items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />Q-Detergent, bleach, and wiping cloths (cleaning towels). <br />'£5Tub to store wiping doths in bleach solution. <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 />Extm fcs Bags t Food Containars must de ■ <br />stofrd fl nchas ofroftha ground! ■