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Environmental Health Department <br />below <br />11. <br />OR <br />12. <br />13. <br />kcz~ <br />14.Completed by: <br />Signature Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove <br />Rinse Water <br />Fire Extinguisher <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Ice Cooler <br />preparation ai <br />this event:'S-2- <br />L <br />Soap and Water <br />M.Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />I^Paper towels and pump-style soap container. <br />- <br />10. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods <br />Propane Tank <br />-----------------------J <br />^Important** <br />Garbage <br />Can <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 />,operation. Return original to festival coordinator three weeks prior to <br />Title Date <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />LI Three compartment sink. <br /> Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground! ’ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www sjqov oro/ehd <br />Pag® e of 11 ^EMP LeNT APP <br />Names of responsible persons to be present in booth during all hours of operation: <br />^>kez~ vn A / _ <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 />®£>etergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />- <br />1 am | <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />L] Ice chests gj Refrigerator <br />□ Refrigerated truck [j Ice bath and tubs <br />□ Other (specify) ________________ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: 3 <br />Extra <br />Water