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Environmental Health Department <br />11. <br />OR <br />12.utensil wash within my <br />13. <br />“Important** <br />Completed by: 14. <br />Title DateSignature <br />ilth Permit <br /> Paper Hand Towels <br />Soap dispenser <br />Bleacn <br />.0",' <br />Bleach and WaterRinse Water <br />Page 8 of 11 <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitize* bucket­ <br />bleach & water for <br />stonng wiping cloths <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 <br />MO Gal. <br />Hand wash Water <br />1 Extra <br />Water <br />sms within my booth for the sanitary cleaning of food preparation utensil <br />10. <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />_________________z <br />Soap and Water <br />I Tiro Extlngufcher | <br />blHiII <br />II1' '3' : <br />B:-.. . <br />JZfwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />^fone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />£3*Paper towels and pump-style soap container. <br />J a™ providing the following itei <br />□ Three compartment sink. <br />| “w "ater' ,or «»»<• <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />GI Tub to store wiping cloths in bleach solution. <br />209 464-0138 | www.sjgov^rg/ehdpp <br />Names of responsible persons to be present in booth during all hours of operation. <br />boothPr°ViCiin9 tKe follOW'n9 for adecluate hand washing facilities, but separate from <br />EitrnK* Bags 4 Food Conlalners must b» I <br />sforod 8 inches otfot the ground ■ <br />Eelton Avenue | Stockton, California 95205^ T^ 209 468-3420 | F <br />ife <br />Ey~ <br />SANJOAOUIN <br />------COUNTY------ <br />C'Tcrtn-n 9/OM,s ;1ere <br />po“ally teardous '“ds <br />SS S O Refrigerator <br />□ Refrigerated truck Q lce bath and tubs <br />□ Other (specify) <br />Garbage <br />Can <br />ting Board