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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />Completed by:14. <br />ilgnature <br />Health Permit -I <br />Paper Hand Towela <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />D-U it <br />Bleach and WaterRinse Water <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <br />5-20 Gal <br />Hand wash Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Sternow/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket- <br />bleach & water Ibr <br />storing wiping doths <br />Extra Ice Bags i Food Contalnan must be j <br />stand 8 Inches off cf Un ground! J <br />Soap and Water <br />■ ■ A <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAQUIN <br />• —county---- <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 41 °F temperature): <br />gj-lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ _ <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 operatjop: Betum original to festival coordinator three weeks prior to <br />this evenV // // / <br />Title <br />Garbage <br />Can <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EH0 10-02 Page 8 of 11 'tvtN <br />06/29/2023 <br />0 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 />gf 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 />^gfwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />4^ Paper towels and pump-style soap container. <br />Names of responsible persons to be present In booth during all hours of operation; <br />_______________________________