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Environmemai Health Department <br />10. <br />11. <br />12. <br />13 <br />Important** <br />Comp'eted by14. <br />Pruporic Tunii <br />I <br />Ice Cooler <br />I* <br />Nances responsible person^ to be present in booth during all hours of operation’ <br />Vi -X___r. ~y ...............- j <br />■ _•—Va' ----_y. e-wxr.y- - " —'- -I-A - ‘ ‘ <br />5 Gut Hw«a vvuih <br />Wa&lcwntof C<xrtairi9i <br />Suntixc? twckci <br />b<eact> a water fcr <br />iloHnn wiping doth* <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Sfone separate tub (bucket or basin) for the collection of rinse/wastcwater. <br />JXfPaner towels and pump-styie soap container. <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Ta<p <br />Garbage <br />Car. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth’ <br />j&lce chests <br /> Refrigerated truck <br /> Other (specify) <br />IErfra lea Oagt & Food Containers must bo <br />stored 8 Indies otf of the gmundl <br />SANJOAOUiN <br />------COUNTY------ <br />Greotness grows here <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />Is i-=~d ths fc-l’c-wfn-s dsy. msnts-n hsfo^AI’f tampsrahtre): <br />I i Refrigerator <br />Klee bath and tubs <br />i----------------------Culling Board <br />am prov ding the following items within my booth for the sanitary cleaning of food preparation utensil <br />C] Three comoartment 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />i J Tub to store wiping cloths in bleach solution <br />1868 E. Hazelton Avenue] Stockton. California 95205 ] T 209 468 3420! F 209 464-0133 ] www.sjcehd.com <br />EHD 16-02 Pago 8 of 11 TCMP APP <br />U7/3/17 <br />| Health Permit <br />I -.-1“ H r <br />I <br />All food vendor booths are subject to inspection. Please make a copy of this application n <br />preparation for this event A copy of this checklist must be in the booth at all hours of <br />preparation operation. Rotyn original to festival coordinator three weeks prior to <br />this evej <br />i Paper H or-.l Tow is | <br />RIfiso WalerSoap ond Waler <br />5-20 Gal. <br />Hand wash Water <br />Stomo w/ChoHirg <br />Dish