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SANJOAOUIN Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />Z <br />Propane Tank <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />dJ <br />fl! <br />Soap and Water <br />EE <br />Rinse Water <br />EHD 16-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />blaach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Storno w/Chafflng <br />Dish <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Extra Ico Bogs & Food Contolnors must bo <br />storod 6 Inchos otf of tho ground! <br />'L'EE. - ------COUNTY------- <br />Greatness grows here. <br />I am 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 />^QTce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />(J <br />Signature <br />Health Permit |1 <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. iC c) <br />.ETWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />425006 separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E^fPaper towels and pump-style soap container. <br />Title Date <br />10. <br />^Important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />________\ (J < Aj) < C V > Y~\___________________ <br />Efl^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 />EJ Detergent, bleach, and wiping cloths (cleaning towels). <br />•QTub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />-I-1C22 Page 6 of 11 TEMP EVENT APR <br />^-7