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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />® Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />‘‘Important** <br />14.Completed by: <br />7 Signature <br />Health Permit <br />PnporHand Towels <br />Soap dispenser <br />Cutting Board A.Propane Stove Bleocti <br />Propane Tank <br />Rinse Water □loach and Wotor <br />Fire Extinguisher <br />Ice Cooler <br />® Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />® One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra Ice Bags 6 Food Containers must be <br />stored 6 Inches off of the ground! <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. <br />Garbage <br />Can <br />Sanltlzor buckot- <br />bloacli 4 wator for <br />storing wiping clolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Contolner <br />5-20 Gal. <br />Hand wash Water <br />Title <br />L <br />Soap end Water <br />Date <br />SANJOAOUIN <br />-----COUNTY------ <br />Greatness 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 />S Ice chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs v - <br />□ Other (specify)Mo hAWckuS I IQC. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />SI Three compartment sink. <br />^am^providing the following for adequate hand washing facilities, but separate from utensil wash within my <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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />® Tub to store wiping cloths In bleach solution. <br />-J <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www sicehd com <br />^S-02 pageeofll TEMPEVENTAPP <br />Ur/O/l / <br />Extra <br />Water