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2-ocl) <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br /> <br />14. <br />Title <br />Papor Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />D i <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />Extra /ce Bags & Food Containers must bo <br />stored 6 inches oft of the ground! <br />Extra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <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 />-------------------- <br />Health Permit <br />SAN JOAQUIN <br />C OU N tv <br />□ Water 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 />□ Paper towels and pump-style soap container. <br />□ b°Oth deanin9 °f f0od ^sll <br />Ice Cooler <br />. ___ _ JZ <br />a this event. <br />Completed by: <br />Signature <br />pun Haze,ton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov orq/ehd <br />OMlSS HogoaofU TEMP EVENT APR <br />“Important** <br />boaorth:Pr°Vidin9 the fOilOWin9 fOr adet’uate hand washir|9 facill,ies- but separate from utensil wash within my <br />1 d=71 I-tj r iZ <br />I <br />Soap and Water <br />1 <br />□ Ice chests ^Refrigerator <br />□ Refrigerated truck [J Ice bath and tubs <br />□ Other (specify) <br />2Jion S°aPy Wa‘er' °ne f°r rinSin9 and °"e f°r 3 bteach <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />U Tub to store wiping cloths in bleach solution. <br />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 />" and,)°Peration- Return original to festival coordinator three weeks prior to <br /> ^^2(7^ <br />Date