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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />7 <br />14.Completed by. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutbng Board <br />BlaachPropane Stove <br />Propane Tank <br />Rinse Waler Bteacti and WaterSoap and Water <br />Fire Ertlnpulsher <br />TEMP EVENT APP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra <br />Water <br />5-20 Gai. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />slonng wiping doths <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra Ice Begs & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />^1 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />**lmportant**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 />O^e 5/^ <br />Title Date <br />Names of responsible persons to be presept in booth during all hours of operation: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping doths in bleach solution. <br />---------------Ice Cooler < <br />St <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www sioov oro/ehd^°8;^2 ‘ TEMPEST Al <br />^WNJOAOUIN <br />------COUNTY------ <br />Grcotness grows 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 />^Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)