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Environmer ’ Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important'* <br />Completed by:14. <br />Da <br /> <br />Signatui <br />Health Permit <br />"1 Paper Hand Towoto <br />Soap dtapcHMt <br />Cuttsxj Board <br />BtoachPropa/M* Stove <br />i <br />IT aok <br />Bieach and WaterRinae Water <br />Fire ELdinguleher <br />Exira <br />Water <br />Q/6ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />EJ Paper towels and pump-style soap container. <br />Stemo wVChaflHMJ <br />Dish <br />SGteHandMMh <br />Wastewater ConLaoer <br />5-20 Gai <br />Handwash Water <br />Extra tea flays 4 Ftxxf Contar^n must ba <br />ODfad 6 inches off of lha ground’ <br />Sanatzer bucteai- <br />bteach 4 water tor <br />ttonng wtptog ctoVM <br />S&N moi.. <br />COUNTY - <br />___L <br />Soap «nd Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />O' 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 my <br />booth: <br />□^Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />1868 E Hazelton Avenue | Stockton. California 95205 | T,209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />-vr*«»r> r*v • rso <br />Ice Cooler <br />I am providing the following cold temperature control for the cold holding of potential hazardous foods below <br />45°F (if food is used the following day, maintain below 41‘F temperature): <br />[yf^lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)-------- ----------------------------------—-------------------------------------------------- <br />Names of responsible persons to be present in booth during all hours of operation: <br />>y U va-k r' y o __________________________________ <br />Ail 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 <br />5 <br />Gart>ag« <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />--------------------------------------------------i