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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />this event <br />Completed by: 14.date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />z.Fire Extinguisher <br />Ice Cooler <br />B <br />I <br />Soap and Water <br />I am providing the <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffmg <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />1868 E. Hazelton Avenue | Stockton. California 95205 |^ J <br />EHD 16-02 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Paper towels and pump-style soap container. <br />[Sponsible persons to be present in booth during all hours of operation: <br />/ J 3 0 _________—-—■ <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 operatipn. Return original to festival coordinator three weeks prio.r_to <br />_?/? y <br />Title Date <br />Rinse Water <br />’ 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 of 11 <br />Names c^re: <br />SANxIOAQUIN <br />5 UW? ' ------COUNTY------ <br />Greotness grows here <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day. maintain below 41 °F temperature): <br />tzTice chests D Refrigerator <br />Q Refrigerated truck Q Ice bath and tubs <br /> Other (specify)-------------------------------------------------------------------------------- <br />Bleach and Water <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 /> 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 />JTfDetergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />following for adequate hand washing facilities, but separate from utensil wash within my