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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by14. <br />Health Permit <br />1-dpef ■tar<1 Toweis <br />Soap dispenser <br />Bleach-ycpane Stove <br />Propane T ark <br />V.a»e' <br />Ice Cooler <br />TEMP EVENT APP <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 />f^l Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__ _______ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Slemo wOiortng <br />OsM <br />5 Gal Hard wash <br />Aaslewater Corrtarrrer <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gai <br />Hand wash Wata <br />Ducket- <br />ttoadi & watw tor <br />storing *fing cknhs <br />SAN JOAQUIN <br />COUNTY <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 />I <br />Soap and Water <br />Title <br />M 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 gallon of water). <br />® Detergent, bleach, and wiping dull is (deaning tuwels). <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 />—..Hl - ------------------------------------------------------------- - <br />"J / \ C C z_____________________________________ <br />Important** 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. Z <br />ijJ <br />S/gn/ture <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHD 16-02 Page 0 of 11 TZ“r Z'.'ZMT .‘2 <br />06/19/19 <br />e«t/a fce Sags S Food Containers inust be I; <br />sftyed « mcftes off of ffw graund' <br />3 U 0 lxJUL <br />z-x I I fi'e Exkngmsher