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Environmental Health Department <br />12. <br />13. <br />“Important** <br />Title C Date <br />14.Completed by: <br />signature Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Beard <br />Propane Stove Bleach <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />a <br />V <br />=3 <br />Soap and Water <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^0 Three compartment sink. <br />OR <br />Ice Cooler <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 gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <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. / r . / <br />I hours of operation: <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br /><✓0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0"One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />P'Paper towels and pump-style soap container. <br />Names of responsible personsto be present in booth during all <br />Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground! <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420) F 209 464-0138 I wwwsicehdcom <br />XT02 PageBofll TEMP EVENT APP <br />fR^SANJOAOUIN <br />— COUNTY— <br />Greatness grows here. <br />10. lam 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 ^^Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify)