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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Cl14.Completed by: <br />Health Permit <br />Paper Hand Towel* <br />Cutting Board <br />Propane Stove <br />Soap and Water Rlnee Water Bleach and Water <br />Ice Cooler 5G«IHv>dw«»h <br />WasUwatar Coniabwr <br />Garbage <br />Can <br />'KJ Water supply dispenser with warm water at a minimum of lOO’F (i.e. 5-20 gallon container with spigot). <br />”51 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />® Paper towels and pump-style soap container. <br />Stemo wfChaffing <br />DHh <br />Booth must be or <br />Concrete, Asphall <br />Plywood, or a Taq <br />Extra <br />Water <br />5-20 Gel. <br />Hand wash Water <br />Sanitizer bucket- <br />Weech & water for <br />skxing wiping cloths <br />Title <br />SAN JOAQUIN <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 /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_____________________________________ <br />Propane Tank <br />------------------------1 <br />"53 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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />B Tub 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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />II/.QJ) <br />Signature z <br />Names ^responsible persons to bepresent in booth during all hours of operation: <br />**lmportant** <br />Are Extinguisher <br />Extm let Bags S Food Containan must ba H <br />sKrad B Incbas off of tha ground! II <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />0TOlT°2 Pa9*’ 8 °f 11 TEMP EVENT APP <br />Soap diSDonsor