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Environmental Health Department <br />10. <br />11. <br />OR <br />12.my <br />13. <br />‘‘Important** <br />14.Completed by: <br />Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br /> <br />I I <br />Propane Tank <br />/Rinse Water <br />Fire ExtinguisherG <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 />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 />Signature <br />Soap and Water <br />SThTeecompartm^ b0°th f°rthe San‘tary cleaning of food PreParation utensil <br />S Water supply dispenser with warm water at a minimum of 1 GOT (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 />Ice Cooler •J <br />Sultontonelablespoon^f bleac^pe^gaTon'Tfvrater)16 006 f°r 3 <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />o[ <br />Bleach and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />EHD6wo?HaZelt0n AvenUe| Stockton- California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />OeZi g Page 8 of 11 TEMP EVENT APR <br />Names of responsible persons to be present in booth during all hours of operation: <br />Mflfl—'L fecyr'i AJcirta <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 operatipn. Return original to festival coordinator three weeks prior to <br />thisXvent. <br />SAIWOAQUIN <br />-----COUNTY----- <br />fFO^ Greatness grows here. <br />' 45T7if food 'T T'd te7erature contral for lhe cold holding of potentially hazardous foods below <br />4b b (if food is used the following day, maintain below 41 °F temperature): <br />B Ice chests Q Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify)