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Environmental Health Department <br />10. <br />11.thefollowing items within my booth for the sanitary cleaning of food preparation utensil <br />OR <br />12. <br />13. <br />••Important** <br />Completed by: 14. <br />Signatui <br />Health Permit <br />Papor H«id Tovvii <br />StMpdipwuar ---------- <br />Soap and water Rrua Water Beam end Water <br />Pre EiSnvilber <br />Ice Cooler <br />PageSotll <br />Soruuer txxaet- <br />Meem Avatar lor <br />etortng atpkig dm <br />EHD 16-02 <br />W1W18 <br />Stamo aTChaHng <br />Dbh <br />5 G« Hand warn <br />Waatawatar Contaner <br />5-ro ga <br />Hand wain Water <br />Q_yyater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />ET^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[Draper towels and pump-style soap container. <br />Ejrln ka Btgt I Food Conltiwi mutt t>e <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />Q <br />Title <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 eventz/ <br /> y-/ z-^3 <br />Date <br />- <br />\ -a? ,> <br />Propvm T mk I <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. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SANJOAQUIN <br />------COUNTY------ <br />G'catncis growj here. <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 />E] Ice chests ©Refrigerator <br />Q Refrigerated truck Q Ice bath and tubs <br />□ Other (specify) <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 at 11 TEMP EVENT APP <br />J Cugxig Board | <br />PropamSSMi . <br />Names of responsible persons to be psesent in booth during all hours of operation: <br />____A( •£-&.______________________________