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* <br />Environmental Health Department <br />10. <br />11. <br />OR <br />I <br />12. <br />13. <br />**lmpoi mt** <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Scapctspcrtsc? <br />cucna Board <br />acnd-.Prtyune Eaave <br />fl <br />Procent Terft <br />RnetWaW <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />I am providing the following for adequate hand washing facffities, but separate from utensil wash within my <br />booth: <br />Extra <br />Water <br />QHn ic» Ba^a 8 foot Coetstera exot t>e slona trxtmoUcfgiagmndt <br />SGsiHantfwsh <br />WssfeMttflr Cocusr <br />SanSn? budlfi^ <br />DtwtfiSwatwfor <br />acting wtptnj dora <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, ora Tarp. <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 Q-Refrigerator <br />□ Refrigerated truck bath and tubs <br />O Other (specify)_________________________________________________________ <br />Swno WChsfEng <br />D«tv <br />SAN JOAOUIN <br />------COUN-V — <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 rinsefwastewater. <br />Q^apor towels and pump-style soap container. <br />Nam^oh^^nsib^ers^ togj^esent in booth during aS hours of operation: <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 />SlzThree 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub 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 />EHD 10-02 PagedoHI TEW»EVB*TTAPP <br />0GZ2a^023 <br />Garbage <br />Can <br />I-—- I <br />5-20 Gat. <br />Hand wMhVM&r <br />efcacfiwd Water ____ <br />jnsnz7 <br />Sound Wats