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Environmental Health Department <br />10 <br />11.lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />H Three compartment sink. <br />OR <br />12. <br />13. <br />"Important** <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cuttinq Board <br />Propane Stove BleacT <br />Propane Tank <br />Soap and Water Rinse Water Bloacn and Water <br />Fire Extlnqusher <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sigov.org/ehd <br />Pa9e 8 of 11 TEMP EVENT AfTEMP EVENT APP06/19/19 <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br /> Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />5-20 Gal <br />Hand wash Water <br />Sanitizer oucket- <br />bleach a water for <br />storing wiping cloths <br />SAN JOAQUIN <br />------COUNTY------- <br />QUO CT <br />Title <br />Extra fee Bags & Food Containers must be I' <br />stored 6 inches oft ot the ground' J. <br />5 Gal Hand wash <br />Wastewater Container <br />Ice Cooler <br />_________/ <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewate;. <br /> Paper towels and pump-style soap container. <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 day, maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br />[Vj Refrigerated truck Ice bath and tubs <br /> Other (specify)_________________________________ <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 />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 />0^) 112 |l^ <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: