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Environmental Health Department <br />" I <br />10. <br />11.I ai <br />OR <br />12. <br />[D<5rie separate tub (bucket or basin) for the collection of rinse/wastewater. <br />pt^aper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by: 14. <br />I’npor Hand Towels <br />Soap disponsor <br />(llonch <br />Propane Tank <br />Bleach mid WntorSoap nnd Wntor <br />l-'lro Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <br />Extra <br />Water <br />5 Gal I land wash <br />Wastewater Conlainor <br />Garbage <br />Can <br />Sanitizer buckot- <br />blonch A water (or <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Stomo w/Ghntfing <br />Dish <br />5-20 Gal. <br />I land wash Wntor <br />Names of responsible persons to be present in booth during all hours of operation: <br />z <br />Rinse Water <br />SignatprfJ/ <br />-roviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />'Three compartment sink. <br />^fhree 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 />[Z^VVater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <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<7 S_____7- <br />Title Date <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />1 x i-r'a r—» »r*•>«*»- a a <br />EHD 16-02 Pago 8 of 11 . -- <br />06/19/19 <br />Cutting Board -------- <br />Propano Stovo , I <br /> X <br />| Health Permit <br />SAN JOAQUIN <br />. |',.j ’ ------COUNTY— <br />..tr, ...a- <br />l(1 v.v' (neotiicss yrows ht-ic <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 />01ce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).____ _