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11111 <br />41110 <br />, • , <br /> <br />Soap and Water Rinse Water <br /> <br />Fire Extinguisher <br /> <br />Bleach and Water <br />SAN JOAQUIN <br />--COUNTY <br />Environmental Health Department <br />1-7 S r <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 />El Ice chests Refrigerator <br />Ej Refrigerated truck 17 Ice bath and tubs <br />Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />›,hree compartment sink. <br />OR <br />LI 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 />EI 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 />).,\Nater sup dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />/61.D. ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />paper towels and pump-style soap container. <br />Nam s of responsibie persons to be present in booth during all hours of operation: <br />114, \IV \cr <br />"Important' 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 />*. Completed by: <br />Signature <br /> <br />Title <br /> <br />Date <br />Garbage <br />Can <br />Health Permit <br />Sterno w/Chaffing <br />Dish <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Soap dispenser <br />Bleach <br />Paper Hand Towels <br />Sanittzer bucket- <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Ice Cooler <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/29/2023