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Environmental Health Department <br />I am10. <br />11. <br />OR <br />12. <br />Completed by: 14. <br />Health Permit <br />] <br />Paper Hand Towels <br />Soap dispenser <br />Cultinp Board <br />BleachPropane Stove <br />f <br />FT <br />Propane Tank <br />Soap and Water <br />]Fire Extinguisher <br />TEMP EVENT APP <br />la <br />Rinse Water <br />Extra Ice Bags i Food Containers must be <br />stored 6 inches off of the ground! <br />laintain below 41 °F temperature): <br />Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Ice Cooler <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Extra <br />Water <br />% <br />~~ <br />"Important** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[^2^Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[fflone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[p^aper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />I a^y providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />iWThree 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 />ffl^ietergent, bleach, and wiping cloths (cleaning towels). <br />®Tub to store wiping cloths in bleach solution. <br />&S>'■ ‘ .... <br />U —J1 J <br />SAN JOAQUIN <br />------COUNTY------ <br />Greotness grows here. <br />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 <br />□ Refrigerated truck <br />□ Other (specify) <br />Garbage <br />Can <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjcehd.corn <br />EHD 1M)2 Page 8 of 11 TEMP EVEHI <br />07/3/17 <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 oriqinai to festivai coordinator three weeks prior to <br />'Signature' Title Date