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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Important1 <br />14.Completed by: <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 3Propane Stove Bleach <br />0JIfl <br />Propane Tank <br />Rinse Water Bleach and Water <br />Ice Cooler <br />Page 8 of 11 <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 GaL <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Stemo w/Chafftng <br />Dish <br />1868 E. <br />EHD 16-02 <br />06/19/19 <br />______________ <br />Exira Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Health Permit <br />SAN JOAQUIN <br />-COUNTY- <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />GJ^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />___<9 J r'-vo_______________________________ <br />Title <br />__J <br />Soap and Water <br />Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 I www.sigov.orq/ehd <br />Page 8 of 11 TEMP EVENT APP <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />------------------ ---------------------t <br />Date <br />Three com th^>lloJA,in9kitems within booth forthe sanitary cleaning of food preparation utensil <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 /> Tub to store wiping cloths in bleach solution. <br />' ^o^in9 follow’n9 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 J7] Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) <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 />(^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />•** <br />Garbage <br />Can