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Environmental Health Department <br />11. <br />OR <br />12. <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 />7V- <br />U <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11 <br />_L <br />Soap and Water <br />Extra tee Sags & 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 />& 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 />Paper towels and pump-style soap container. <br />01 <br />Ice Cooler <br />‘‘Important** <br />0 Three compartment^0^'k"18 ^b Sanitary cleanin9 of food preparation utensil <br />.•xCl- <br />a-- / <br />10. <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, I ' --------- <br />----------------------------(■ _____________________________________________/(g <br />Signature^ Title Date <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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />; y5 f <br />I am | <br />45°F (if food is used the following day, maintain below 41 °F temperature)': <br />S-Refrigerator <br />□ Ice bath and tubs <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I <br />d <br />Names of responsible persons to be present in booth during all hours of operation: <br /> feJlTaWH—Lodarte ,__UifdiA (Xuctm, fYm Ortiz, AhrgH/ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: 1 <br />SANJOAOUIN <br />------COUNTY------- <br />Greotness grows here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />S'Ice chests <br />□ Refrigerated truck <br />□ Other (specify)