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Environmental Health Department <br />I am.11. <br />12. <br />13. <br /> <br /> Completed by: 14. <br />Health Permit <br />Paper Hand Towels1Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />209 464-0138 | www.sjgov.org/ehd, California 95205 | T 209 468-3420 | F TEMP EVENT APP <br />Partfi R nf 11 <br />Extra Ice Bags 4 Food Containers must t>e <br />stored 6 inches ofl ot the ground1 <br />Stemo w/Chaffing <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 />stonng wiping cloths <br />“j control for the cold holding of potentially hazardous foods below <br />intain below 41 °F temperature): <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />1868 E. Hazelton Avenue | Stockton <br />“Important <br />S.a<J,N <br />10. <br />pa per towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of <br />'DateTi^e <br />Soap and Water <br />SAN»JOAOUIN <br />“V'■ -----COUNTY------ <br />■'r Greotness grows here. <br />I am providing the following cold temperature <br />45°F (if food is used the following day, maj./ <br />chests [^-Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />■ ~ <br />Rinse Water <br />•oviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />hree compartment sink. <br />0R Ca^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 />jxfbetergent, bleach, and wiping cloths (cleaning towels). <br />' j^TTub 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 />J^Water supply dispenser with warm water at a minimum of 100‘F (i.e. 5-20 gallon container with spigot). <br />OOne separate tub (bucket or basin) for the collection of rinse/wastewater.