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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Health Permit <br />Paper Hand Tcw/eb <br />Cultlrxi Beard 1 BleachPropane Stove <br />it <br />Propane Tank <br />Bleach and Waler <br />fl <br />TEMP EVENT APP <br />Extra <br />Waler <br />&-20 Gal <br />Hand washWater <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Stemow/ChaHing <br />Osh <br />5QalHandwasl> <br />Wastewater Container <br />Sartfizer bucket <br />Head) & water for <br />storing wiping cloths <br />SAN JOAQUIN <br />------COUNTY------ <br />_______ <br />Ice Cooler <br />Extra fee Bags 4 Food Corfeiwrsmuslbo j <br />stonsde/nc/rosofforOBgrorxxt' J <br />_z <br />Rinse Water <br />"’Important** <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjcehd.c™ <br />EHD 16-02 <br />07/3/17 <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 daynpaintain below 41 °F temperature): <br /> Ice chests □'Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)------------------------------------------------------------------------------------------------------------------------- <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□reaper towels and pump-style soap container. <br />Names ofresponsible persons to be present in booth during all hours of operation: <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 pnor tg <br />this event <br />Signati/e Title Date <br />|__| FliB Fxflnflutoher <br />I amprdviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />H'fhree compartment 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 /> 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 /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot).