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Environmental Health Department <br />Greatness <br />10. <br />11. <br />OR <br />12. <br />13. <br />-r <br />Completed by: 14. <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />Soap and Water Rinse Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />SANJOAOUIN <br />------COUNTY------ <br /> Water supply dispenser with warm wat^r at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />ejection of rinse/wastewater. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br /> Three 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 ga/ljokof water). <br /> Detergent, bleach, and wiping glofhs (cleaning towels). <br /> Tub to store wiping cloths in bleach!solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />VincptTTi , Pk Qvn <br />1 <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 />____________________________ <br />Signature Title Date <br />“Important** <br /> One separate tub (bucket or basin) for tme <br />r ' Paper towels and pump-style soap container. <br />» .Ul.v <br />.■ <br />' Greatness grows here. <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 H Refrigerator tYuc-C- <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_