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Environmental Health Department <br />0. <br />11. <br />OR <br />12 <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I www.sicehd.com <br />™?. 1®'°2 Page 8 Of 11 TEMP EVENTTEMP EVENT APP <br />________________ <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 operation Return original to festival coordinator three weeks prior to <br />this event Z? <br />Sterno w/Chaffing <br />Dish <br />Exira <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 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 />____L <br />Soap and Water <br />Signature Title <br />Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground! j ■ <br />“Important** <br />03-2T-'1 <br />Date <br />Propane Tank ---------------! <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />S/Fhree 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 />LJ45etergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />J&OAQUIN <br />,^*7 ------COUNTY;------ <br />Greatness grows here. <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 Refrigerator <br />ETRefrigerated truck Ice bath and tubs <br />0 Other (specify) CQOllr <br />^amproviding the following for adequate hand washing facilities, but separate from utensil wash within my <br />O'Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 O^ire separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />lYW. fabiWUn- <br />Soap dispenser <br />Bleach