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1 <br />Environmental Health Department <br />10. <br />; withi11. <br />OR <br />12.Ilovwng for adequate hand washing facilities, but separate from utensil wash within my <br />□ Water <br />□ Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />important** <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Cuttino Board <br />BleachPropane Stowe <br />Propane Tank <br />Soap and Water Rinee Water Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11EHD 16-02 <br />07/3/17 <br />I am providing the <br />booth: / <br />minimum), one for soapy water, one for rinsing and one for a bleach <br />per gallon of water). <br />pfhg doths (deaning towels). <br />in bleach solution. <br />5 Gal Hand wash <br />Wastawatar Container <br />ig of potentially hazardous foods below <br />ire): <br />iply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ Ope separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Stomo wfChafHng <br />CM th <br />Sankizer buckat- <br />Haaoh & water for <br />storing wfplna doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />□ Refrigerator <br />□ Ice bath and tubs <br />Garbage <br />Can <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness crews here. <br />I am providing the following cold temperature control for the cold holdji <br />45°F (if food is used the following day, maintain below 41 °F temp^rdfr <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify)__ <br />for the sanitary deaning of food preparation utensil <br />--------4Ice Cooler T <br />________F Extm Ice Bag* & Food Cootainora must be ■ <br />stated 6 inches oK of the ground! ® <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 pripr to <br />this evgnt. k. ' / <br />J ~ SignatGr^ Title’ Date <br />I am providing the following items within my <br />□ Three compartment sink. <br />□ Three deep tubs (basins 6-8 ii <br />solution (one tablespoon of bl< <br />□ Detergent, bleach, and <br />□ Tub to store wiping dot <br />5-20 Gel. <br />r- Hand wash Water <br />Soap dispenser I \ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />TEMP EVENT APP