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Environmental Health Department <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 100°F (i e. 5-20 gallon container with spigot). <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Pap<K Hand Toweft <br />Breach <br />f <br />Propane Tank <br />Soap and Water Bleach and Water <br />Fie Extingushef <br />Garbage' <br />Gan <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />SGaiHand wesh <br />Wastewater Contew <br />5-20 Gai <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chaffmg <br />Dish <br />Saniizarbucfcat- <br />bteach & water for <br />atorirtO wiping cfotns <br />Title <br />13 One separate tub (bucket or basin) for the coiiection of rinse/wastewater. <br />Paper towels and pump-style soap container. <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 />( 11 /v4~) v\ z/V______________OvovkJtz/ <br />Date <br /> <br />1868 E Hazelton Avenue | Stockton, California 952051 T 209 468-3420 ] F 209 464-0138 | www sjgov orgtehd <br />^H?J.6;02 Page 5 of 11 TEMP EVENT AFP <br />“Important'* <br />.. 7 .-V . <br />■ <br />10. <br />r-----------------------------\ <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br /><.. ~ z <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />LJ Tub to store wiping cioths in bieach solution. <br />SMJOAOUIN <br />----<OUNTY------ <br />'Greatness grows here. <br />I am providing the following cold temperature control for foe coid holding of poienuaily hazardous foods below <br />45°F (if food is used foe following day, maintain below 41dF temperature): <br /> Ice chests Refrigerator <br />O Refrigerated truck Ice bath and tubs <br /> Other (specify)______________________________ _______________________ <br />Extra /co B&gi i Food Containers rnusl be ■ <br />. bic.Td £ incfnas off ths B <br />Names of responsible persons to be present in bocth during all hours of operation: <br />Cutting Board <br />Propane Stove <br />Extia <br />Water <br />Ice Cooler ? <br />i Jk