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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />Health Permit <br />Paper Hand Towels <br />Bleach <br />Propane T ank <br />Blcacb and Waler <br />File Extinguisher <br />Page 8 of 11 <br />II <br />Water 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 />Paper towels and pump-style soap container. <br />Exira fco Bags 4 food Containers must bo <br />stored 6 inches off of the oroundl <br />Extra <br />Water <br />6 Gal Hand wash <br />Waslewaier Conlalnar <br />Garbage <br />Can <br />Saritizor bucket­ <br />bleach 8 water lor <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp, <br />Stemo w/Charhng <br />Dish <br />F 209 464-0138 | VAVW.sjcehd.com <br />TEMP EVENT APP <br />S-20 Gal. <br />Hand wash Water <br />Ice Cooler <br />| Cutting Board <br />Propane Stove <br />| ] |: | <br />Soap and Water <br />Nam^s^f re^nsible^rson^ tob^gr^sent in booth during all hours of operation: <br />fhd no Ha2elton Av0nue | Stockton, California 95205 | T 209 468-3420 | <br />07/3/17 PaoaBofll <br />10. <br />L_ <br />Rinse Water <br />"7 - I <br />Date <br />□ Three compartm0ent^nVtemS Wilh'n b°Olh Sanitary cleanin9 of food preparation utensil <br />SSnernn!1PhfUbS (bas'"* S'8 Jnches 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 />^sJub to store wiping cloths in bleach solution. <br />Soap dispenser | <br />praviding the following for adequate hand washing facilities, but separate from utensil wash within my <br />S AN JOAQUIN <br />n ------COUNTY------ <br />Greolness grows here. <br />‘ the f°Sin?t?Old ten?Perature con,ro1 for the co'd holding of potentially hazardous foods below <br />45 F (if food IS used the following day, maintain below 41°F temperature): <br />■®4ce chests Refrigerator <br /> Refrigerated truck ]S^ce bath and tubs <br />O Other (specify) <br />A" f00d 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 />ttHsyvent, i /ly 4 / C --------- <br />14. Completed by: „ L X <br /> <br />Signature Title