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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />F|re Extinguisher <br />06/19/19 <br />Soap and Water <br />zz: <br />Rinso Water <br /> 'ffVater 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/wastewater. <br />Q'Paper towels and pump-style soap container. <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer buckot- <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Water <br />Stemo w/Chaffing <br />j Dish <br />SAN JOAQUIN <br />COUNTY- - <br />I <br />I am providing the folloyving cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 4TF temperature): <br />□'fee chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ________________ <br />"Important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />Signature <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment ^ink. <br />I <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />soli 'tion (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, ahd wiping cloths (cleaning towels). <br />[7 i ub to store wiping qloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 dvent, irtyrt') . <br /> <br />Title 'Date <br />: Ice Cooler <br />>Extra Ice Bags <S Food Containers must be <br />stored 6 inches off of the ground! <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19 <br />Cutting Board