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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Nai <br />Important** <br />14.Completed by; <br />Signature <br />Paper Hand Towel* <br />Soap dispenser <br />Cutl'no Board aProp ano Save <br />L <br />Propane Tank <br />Fira ExUnguiihor <br />Ice Cooler <br />r___•- ____■ - <br />Health Permit SUmo WChatTmg <br />Dish <br />S Gal Hand wash <br />Wailowaier Container <br />5-20 Gat. <br />Hand wash Wat or <br />Garbage <br />Can <br />Booth must be on <br />Concroto. Asphalt, <br />Plywood, or a Tarp. <br />Extra lea Bogt & Food Conlsinorairunt bo <br />UondSInchatoaalthaQrouniil <br />Extra <br />Wator <br />Sar?izor bucket­ <br />bleach a water for <br />storing wiping doth* <br />SANJOAOUIN <br />-----COUNTY------ <br />Greatness grows here. <br />I Bleach <br />—? <br />Soap and Water <br />tfwater supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />GETOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[SfPaper towels and pump-style soap container. <br />IT <br />Rinse Water <br />■ V <br />•'.«ro*Y* <br />1 f0,?win3 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 />LJ Ice chests Refrigerator <br /> Refrigerated truck lee bath and tubs <br />O Other (specify) <br />I} arn^providing the following for adequate hand washing facilities, but separate from utensil wash within my <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 />Title A4)at6 L' <br />is of responsible persons to be present in booth during all hours of operation: <br />' (aJ / /// S <br />z^n providing thefollowing items within my booth for the sanitary cleaning of food preparation utensil <br />iJXfhree 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 />Qj Detergent, bleach, and wiping cloths (cleaning towels). <br />BTub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 [ T 209 468-3420} F 209 464-0138 | www.sjgov.org/ehd <br />EHD1G-02 Pago 8 of 11 TEfZP EVEWT APP <br />06/19/19