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Environmental Health Department <br />11. <br />OR <br />12. <br />0 Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Signature <br />Paper Hand Jewels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />I <br />Propane T ank <br />Rinse Water Bleach and Waler <br />Firo Extinguishera <br />Ice Cooler <br />S 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 />Extra Ico Bags & Food Containers must bo <br />stored 6 inches olt of lha ground! <br />Ste.rno w/Chaffng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizor bucket­ <br />bleach 8 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Bond wash Water <br />EYC Treasurer <br />Title <br />______ <br />Health Permit I <br />7/03/26 <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />Zach Morgan <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 />17~ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I | <br />10. <br />SAN JOAQUIN <br />------COUNTY------- <br />Grealness grows here. <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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___ _________ <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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 mv <br />booth: 7 <br />Soap and Water <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wwwsjcehdcom <br />n-Xw'02 Pa9°8 of 11 temp event app