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Environmental Health DepartmentSAN JOAQUIN <br />10. <br />11. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />12. <br />13 <br />’“Important4* <br />Completed by:14. <br />Sigii <br />Health Permit <br />Piper Hand Tonols <br />CiHling Hoard <br />(Uoach and Waior <br />Feo Exi'nguthar <br />I <br />TEMP EVENT API' <br />E»fra /co Bapi & food ConHuion must bo <br />tlo/ctl G inches o'lcH'fC giound' <br />r.*w <br />Wolor <br />Garbage <br />Can <br />Sanibiar buckot- <br />bloich & waltr tor <br />itonng wiping ctoihi <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp <br />Sterno w/Chaf/Kio <br />OJh <br />5-?O Gnl <br />Handwash Water <br />Ice Cooler <br />Title <br />____ <br />Propane Slow# <br />rz <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468 -34201 I- 209 464-0138 | www.sjgov org/chd <br />El ID 16 02 Pago 0 o! 11 TEMP EVENT .*.! <br />06/19/19 <br />| SGitllondwosh <br />Wastewater Conta no' <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />^fhree deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />f l Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />iL-WVater supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />(3^ne^separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[i^Paper towels and pump-style soap container. <br />Rmtt Waler <br />| Propane T«nk <br />| Soap dapomor <br />f Bleaai <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 throe weeks prior to <br />this evfin^ 7. j <br />Date <br />I am providing tho 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 />Q4ce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Names of responsible persons to be present in booth during all hours of operation <br />