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Environmental Health Department <br />foods below <br />10 <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />Completed by:14. <br />Tcw»'» <br />Soao 4np«n»«r <br />CulWifl UoaM 1 Blaich <br />PiopanaSkwa <br />0 <br />Propana Tank <br />fllnacii anil Wa'arflnia Waler <br />fue EnkxiuiihrM <br />a.' .., jat ■ I 6 Oai Hand waah <br />WamarMrCordllner <br />Gatbngo <br />Can <br />Booth must bo on <br />Concreto. Asphalt <br />Plywood, or a Tarp <br />S!amo wrChalfV'g <br />O.M <br />S 20 Oal <br />Hand nub Water <br />BaWM buck®!- <br />bleach & »aUi Ice <br />atartnj aXptng tMM <br />SAN JOAQUIN <br />c. ou r 11 y <br />z <br />Soap and Waler <br />1ZZ£- <br />ZgtWater supply dispenser with warm water al a minimum of 100T (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewaler. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 10-02 Page 6 oM I TEMP EVENT A.PP <br />ocnwn <br />Health Permit <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />jgjhree compartment sink. <br /> Three deep tubs (basins 6-8 Incites minimum), one <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 />Ice Cooler <br />,/ ExVb k• A food Ctrxlilnt't mutl !>• <br />6 hchoi c t giwod? <br />I am providing the following cold temperature control (or the cold holding of potentially hazardous <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)----------------------- ---------------------------------—-------------- <br />for soapy water, one for rinsing and ono for a bleach <br />^Japor towels and pump-stv|e§oap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />TO,----------—----------------------- <br />All food vendor booths are subject to Inspection. Ploase make a copy of this application in <br />preparation for this event. A copy of this checklist must be In tho booth al all hours of <br />preparation anyiperalion or'-dlnal to festival coordinator throe weeks prlorto <br />yy Signature Title Oilo/ <br />tilra <br />Willi