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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature <br />Health Permit Slerr <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11 <br />z____ _ <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Hand wash <br />Wastewater ContainGr <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />x^fjh/ater 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 />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Names of responsible persons to be present in bgoth during all hours of operation: <br />a! <br />Extra Icg Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />G <br />_vZ <br />■ t; <br />rw/Chaffing <br />Dish <br />"Important** <br />— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Propane Tank <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 />pre^ratipyandspperation . Return original to festival coordinator three weeks prior to <br />4-] <br />Title Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />QThree 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 tn bleach solution. <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greatness grows here. <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 sj^faefrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__ ______________________________________________________ <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EH016-02 Page 8 of 11 TEMP EVEN! <br />07/3/17 <br />Garbage <br />Can