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Environmental Health Department <br />10. <br />11. <br />OR <br />12.my <br />13. <br />14.Completed by: <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Extra <br />Water <br />Garbage <br />Can <br />www.sjgov.org/ehd <br />TEMP EVENT APP <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 />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />-COUNTY— <br />Greatness grows here <br />_ o <br /> 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 />0 Paper towels and pump-style soap container. <br />y. y—? <br />r/ <br />Rinse Water <br />preparation pnd operation^ Return original to festival coordinator three weeks prior to <br />this eyjBnt./ // ' --------- <br />Z'y <br />— Date <br />> k—■> <br />~i r <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />------J <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 />B Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />S Three c^mpartment^i^ Sanitary cleaning of food Preparation utensil <br />Names of responsible persons to be present in booth during all hours of operation: <br />)L TF (n i ICdSgt i p <br />_ tMarcr la ’ <br />■"Important** <br />L8n?R n; Hazelton AvenLJe I stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I <br />* oik?-' <br />•S'FO^’’7' <br />' the f°!!0"in9 COld temPerature control for the cold holding of potentially hazardous foods below <br />45 I- (if food is used the following day, maintain below 41°F temperature): <br />H Ice chests Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify) <br />n 1—---_j0Se’- s ICOSgt i o flam _____ <br />\gru Ko_______________ ~~ <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 /> IIUI I,, <br />Signature