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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br /> <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Propane Stove Bleach <br />I <br />Bleach and Water <br />Fire Extinguisher <br />. I <br />Soap and 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 />J^TPaper towels and pump-style soap container. <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater ContainerExtra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash 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 />Propane Tank <br />Ice Cooler <br />Rinse Water <br />**lmportant**All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for tttis event, /k copy of this checklist must be in the booth at all hours of <br />preparation and bperfltion. Return original to festival coordinator three weeks prior to <br />3/31^ <br />/ Sigijlatur^ Title “ Date <br />SANJOAQUIN <br />------COUNTY------- <br />Greotness grows here. <br />1 inS the f0^nP COld temPerature con,ral for ‘He cold holding of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41 °F temperature): <br /> Ice chests S’Refrigerator - ZT+Aia r <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify)__________ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />|_J Three compartment sink. <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 />S'Detergent, bleach, and wiping cloths (cleaning towels). <br />j«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 mv <br />booth: J <br />Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 of 11 TEMP EVENT APR <br />