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Environmental Health Department <br />11. <br />OR <br />12. <br />Paper towels and pump-style soap container. <br />131 <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />CulUnp Board <br />Propane Stove D'each <br />Propane Tank <br />RInso Water <br />Piro Exlinouisher <br />Ice Cooler <br />£ <br />Page 8 of 11 <br />Health Permit <br />EHD 16-02 <br />07/3/17 <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />J2T One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />-------Ac r . JA __AaJTHdAJY <br />Sicmo '.v/ChcfTrng <br />D&h <br />5 Ga! Hand wash <br />Wastewater Container <br />Saniliior bucket­ <br />bleach & waler ter <br />Storing wiping cloths <br />Extra <br />Water <br />5-20 Gai. <br />Hand wash Water <br />SANJOAOUIN <br />------COUNTY------ <br />' Date <br />/1Aa A/1^ <br />Title <br />-j. ,7|j <br />Grfra ,'ce Bags & Food Containers must be !' <br />stored 6 inches off of the gmundl aJ <br />^Important** <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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />LJ 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 />this event <br />A aJ TUo aj Y 5/4 AJCrfF ?- <br />Signature <br />3® <br />Bleach and Waler <br />providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />1_sQ£ <br />1868 E. Hazelton Avenue) Stockton, California95205 | T 209468-3420 | F 209 464-0138 | www.sjcehd.com <br />cun«n-> « ... TEMP EVENT APR <br />if, t _ <br />Soap and Waler <br />-.O-U/Z' ’£• v <br />5- i a fck. _____ _ <br />Greotness grows here <br />10. 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 />0^Ice chests Refrigerator <br />/ Refrigerated truck Ice bath and tubs <br /> Other (specify)