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<br />Environmental Health Department <br />10. <br />11. lam providing the following items <br />OR <br />12. <br />13. <br />“Important** <br />14.TitleSignature <br />Popor Hand Towola1Soop dlipcnwr <br />CulUnn Boonl <br />Piopino SIotc <br />fl <br />Piopma Tank <br />Bfoach ond W«l«r <br />Ice Cooler i i <br />alorod 5 Mchoi oil o/ Uw gioundl <br />TEMP EVENT APP <br />Firt! Eidinqather <br />SlomovWCAalSng <br />Olsti <br />6 Gal Hand wa»h <br />Woslowalor ConUlnor <br />Garbfloe <br />Can <br />Sanitiror buckoi- <br />bleach & waler lor <br />Jlorlng wiping dolha <br />Bootfi must bo on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br /> <br />SAN JOAQUIN <br />COUMTY <br />I Blnch <br />Health Permit <br />__ZL <br />Soap ana Water <br />_z <br />Rime Water <br />Extra \ <br />Waler <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)----------------------------------------------—-------------------------- <br />- 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />PagcOoHI TEMP EVE <br />Etln Ico Bagt X Food Conlainm mull bo ’ <br />1868 E. Hazelton Avenue | Stockton, California 95205 ^7 <br />EH010-02 p'-“ <br />06/19/19 <br />■uvn. Please make a copy of this application In <br />checklist must be in the booth at all hours of <br />6-20 GaL <br />Hand waih Walw <br />ns 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />Q 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: PfFT <br /> Water supply dispenser with warm water at a minimum of 100’F (l.e. 6-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br />All food vendor booths are subject to inspection. <br />nronarfltinn for this event. A copy of this G^.wC......----- -- --preparation and operation. Return original to festival <?9C>r(||n^orthree weeks priorto <br /> Completed by:(, *Date