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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />**lmportant** <br />Completed by: 14. <br />Signature Title <br />Health Permit <br />Paper Kand Tcwets <br />Soap dispenser <br />Qjrtmq Board <br />BleachPropane S*o*e <br />Piopar* rank <br />Rnse Water <br />Ice Cooler <br />Soap and Waler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <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 r , <br />Slemo wfChaffmg <br />Dish <br />5 Gal Hoik! wash <br />Waslewaler CoriUmcr <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 4TF temperature): <br />□ Ice chests [^Refrigerator <br />□ Refrigerated truck 0 Ice bath and tubs <br />□ Other (specify)_ ________ <br />H Water supply dispenser with warm water at a minimum of 100°F (i.e 5-20 gallon container with spigot) <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater <br />0 Paper towels and pump-style soap container. <br />Extra <br />W.ilcr <br />Sanrtizer bucket <br />bteach A water tet <br />slonng wiping Ooths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />COUNTY <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />H 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 />0 Detergent, bleach, and wiping cloths (cleaning towels) <br />□ Tub to store wiping cloths in bleach solution. <br />} f/Ua Icti 6. Ffjod CotHarum fmiLt l>o H <br />' hi'Mbd 6 irtfJioi (jff (>i tfm yitjuivi' B <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHD ie-02 Puge B ot 11 TEMP EVENT APP <br />06/18/19 <br />^jTJ <br />Names of responsible persons to be present in booth during all hours of operation: