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Environmental Health DepartmentA' <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />u IJ <br />Propane Tank <br />Fire Extinguisher <br />_____L <br />Soap and Water <br />L___ <br />Rinse Water <br />Stemo w/Chaffing <br />Dish <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 />Extra <br />Water <br />Bleach and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />’^fwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />’fZfOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />'^fpaper towels and pump-style soap container. <br />Ice Cooler <br />Signature <br />insible persons tQ_be presen^ii^booth^urin^ll hours of operation: <br />Greatness <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Q^Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sojtffion (one tablespoon of bleach per gallon of water). <br />"pwetergent, bleach, and wiping cloths (cleaning towels). <br />■0 Tub to store wiping cloths in bleach solution. <br />Names of responsible persons tob< <br /> <br />**lmportant** 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 eventQ/7 ex--------------------------------------------------------------- “ <br /> <br />Title <br />V^SANJOAQUIN <br />-------COUNTY------ <br />grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4^F (if food is used the following day, maintain below 41°F temperature): <br />0 Ice chests Refrigerator <br /> Refrigerated truck '01ce bath and tubs <br /> Other (specify) <br />Extra Ice Bags & Food Containers must be H <br />stored 6 Inches off of the ground! I J <br />| Health Permit <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 8 of 11 TEMP EVENT APR <br />07/01/2024