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SAN JOAQUIN <br /> <br />Environmented Hesffh Deoartmer-. <br />-.-.kU;, <br />Effce chests <br />11. <br />r>Ur\ <br />12. <br />H- Paper towels and pump-style soap container. <br />13. <br />^//^//^14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />1 fBleachPropane Stove <br />J <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />ice Cooler . <br />Soap and Waler <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Waler <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 />i am orovidina the followina items within mv booth for the sanitary cleanino of food oreoaration utensil <br />□ Three compartment sink. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />«*r<+kx <br />tub (bucks! Gi basin) for the coliGCtiOD of nns©/wast6wat©r. <br />J0 <br />I I r\CI J iyu* Cl MUIX <br />M Other (specify) <br />ITl <br />Rinse Waler <br />Title <br />| | IOC MCiLII tai IU LUUO <br />FfWater supply dispenser with warm water at a minimum of 100T (i.e. 5 20 gcilor. c: <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 />Signature <br />"important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />Lid Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsino and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />I- i Detergent bleach, and wioino cloths (cleaning towels). <br />STub 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 />erjnir^i fCr h,s Aciding of ootontiaHv hazardous foods helow <br />. zr.:. :-=s»4"i- remoerafure): <br />□ Refrigerator <br />1868 E. Hazelton Avenue [ Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Garbage <br />Can <br />Cutting Board