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Environmental Health Department <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 />f t---1 I <br />Propane Tank <br />Rinse 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 />Sterno 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 />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal <br />Hand wash Water <br />E-Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />(S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />(S- Paper towels and pump-style soap container. <br />JO <br />-L <br />£ <br />Soap and Water <br />Date <br />^Thi^compartmlnUink'temS W'thin b°Oth San"ary cleanin9 of food Preparation utensil <br />’kaujA/ <br />■ <br />10. <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />SANJOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />' a^rTfd'nThe f0^Tin,9,f°ld temPerature contral f°r 'he cold holding of potentially hazardous foods below <br />45 t- (it food is used the following day, maintain below 41°F temperature): <br />3- Ice chests Refrigerator <br /> Refrigerated truck |ce bath end tubs <br /> Other (specify) <br />Names of responsible persons to be present in booth during all hours of operation: <br />Ok VWl h I — <br />‘‘Important** Z ‘ ............................ <br />JOiL <br />i=]l I <br />EHD?6 02 HaZelt°n AVenUe| stockt°h. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06/19/1 g Pa9e 8 of 11 TEMP EVENT APR <br />; VtkAQnD IHuao <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 /I — <br />________f S'1 <br />SignatureJ