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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cuttinfi Board <br />BleachPropane Stove <br />Rinse WaterSoap and Water Bleach and Water <br />Ice Cooler <br />Sterno w/Challing <br />Dish <br />Extra <br />Water <br />6 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 WaterHealth Permit <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□fpaper towels and pump-style soap container. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />^Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sotdtion (one tablespoon of bleach per gallon of water). <br />SWetergent, bleach, and wiping cloths (cleaning towels). <br />Qi ub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 6 of 11 TEMP EVENT APP <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Eiwi <br />Propana Tank -------------- <br />Names of responsible persons to be present in booth during all hours of operation: <br />_\jdAiP-hA >_____ <br />‘‘Important** 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 />7—- Owxy n/WM <br />Title Date <br />Fire Extinoulshor <br />SAN JOAQUIN <br />-----COUNTY------ <br />GYcotness ijce-tvs lie re, <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 4TF temperature): <br />H Ice chests H Refrigerator <br />□ Refrigerated truck H’lce bath and tubs <br />□ Other (specify) <br />J H i w,' rfuj S 'C,t. L- ■ >