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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />utensil wash within my <br />13.le persons to be pres <br />14.Completed by. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />I <br />Propane Tank <br />Rinse Water <br />Fire Extinguisherfl <br />Ice Cooler <br />Page 8 of 11 <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />5 Gal Hand wash <br />Wastewater Container <br />www.sjcehd.com <br />TEMP EVENT APP <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br />7 7 <br />Soap and Water <br />All food vendor booths are <br />preparation for this event, <br />preparation and operation. <br />this event. ~> ( <br />Extra Ice Bags & Food Containers must be I ? <br />stored 6 inches off of tho ground! <br />1868 E. Hazelton Avenue) Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 I <br />-SThZc^part^nuPnKb0°,h Sa™tary Cleanin9 °f f00d <br />subject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />—_____PrzescpgtfJT 6-13-1^ <br />Title Date <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />IJ^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation- <br />-,r 'T2Ciy / vmAfcCb//An <br />I uVi ic- ) ------------------ <br />^Important** <br /><bas'ns 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 cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />boothPr0Vid'n9 the followin9 for adequate hand washing facilities, but separate from <br />■‘I ! <br />SAN JOAQUIN <br />------COUNTY------- <br />■- Greatness grows here <br />'Qjpe chests Q Refrigerator <br />□ Refrigerated truck '®}lce bath and tubs <br />□ Other (specify)