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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />t <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Extra /co Bags & Food Containers must be <br />storvd 6 inches oft of tho ground! <br />www.sjcehd.com <br />TEMP EVENT APP <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping dotiis <br />( Extra ' <br />I Water <br />□ ThZXa^S.^8 Within my b0°,h f°r ,he Sani,ary Clea™9 °f fo°d utensil <br />Propane Tank j _z <br />Soap and Water Rinse Water <br />SAN JOAOUIN <br />------COUNTY------- <br />Greotnesj prows hero <br />' SS ■— — <br />13 Ice chests □Refrigerator <br />□ Refrigerated truck Q |Ce bath and tubs <br />□ Other (specify) <br />**lm porta nt** <br />5-20 Gal. <br />r- Hand wash Water <br />§ J“aNUesSpo(onaand °"e for a bl-d <br />□ Detergent, bleach, and wiping cloths (cleaning towels) <br />U Tub to store wiping cloths in bleach solution. <br />Bleach <br />Bleach and Water | <br />^providing the following for adequate hand washing facilities, but separate from utensil wash within my <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 />O Paper towels and pump-style soap container. <br />EHD to2 Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 I <br />07/3/17 Page 8 of 11 <br />All food vendor booths are subject to inspection. Please make a copy of this anolication in <br />prenara ton and’nn T"*' p f°Py °f th'S checklist must be in the booth at all hours of <br />thte operatlon Bgturn original to festival coordinator three weeks prior to <br />*11■ s evefli•