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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />“Important** <br />14.Completed by: <br />Signature Title <br />Health Permit <br />P.ipc< Hand Towels <br /> Soap dispenser <br />Culling Board <br />BleachPropane Slow) <br />Propane T ank <br />Rinse Waler <br /> <br />Ice Cooler <br />EHD 16-02 <br />06/19/19 <br />Slerno w/CIwiffinrjDish <br />Exira <br />Walor <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <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 ^EkRefrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)—_____________________________________ <br />Cxlra Ico Bags & I ood Conluitwts must be <br />sloted 6 inches oil ot the ground' <br />Sanitizer buckol- <br />bleaclr & waler for <br />slnring wiping dolhs <br />5-20 Gal <br />I land wash Walor <br />SAN JOAQUIN <br />COU N TY <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />____ _______77 <br />Soap and Waler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />X. <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 />[7 Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solb^ion. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />LJ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/chd <br />”2 Pago 8 of 11 TEMP EVENT APP <br />0 <br />Blcadi flM Walor _______ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparjation 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 I <br /> <br />Date ’ <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: