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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by. 14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Ice Cooler <br />TEMP EVENT APP <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />E^fone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />CZfPaper towels and pump-style soap container. <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Stemo wTChaffing <br />Dish <br />Sanitizer bucket­ <br />bleach a water for <br />storing wiping doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Garbage <br />Can <br />Signature IJ G <br />I am providing the foltowing for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />(ZTvVater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />SAN JOAQUIN <br />-----COUNTY------ <br />Rinse Water <br />.0 <br />Extra Ice Bags 4 Food Containers must be <br />stored 6 inches off of the ground! k-i <br />6/5 <br />Date <br />_z <br />Soap and Water <br />“Important** <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following dayrmaintain below 41 °F temperature): <br />0toe chests Refrigerator <br />□Refrigerated truck. Zfice bath and tubs <br /> Other (specify)_________________________—----------------------------------------- <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 .—.... <br />06/19/19 <br />JxTfhree 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 />□petergent, bleach, and wiping cloths (cleaning towels). <br />z0Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />L 4-/^7 _______________ _________________ <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 S T " /ziroz <br />Title <br />z->. I _ | Fire Extinguisher <br />— <br />Extra <br />Water