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I C.tuno Bowe <br />Prppane Stove <br />Soap 0.Soensal <br />Health Permit <br />5-2U Gal <br />Hand wash Wall., <br />Stem, .00.64,6 <br />Garbage <br />Can <br />bk. If <br />Fag Exiaquahar <br />r <br />ice Cooler <br />rr F./. It al adp 4 'cod Cortt.tx.,, MAJ‘l tog <br />flu,w1 6 .PCINIS pef of Vito tr.100' <br />5 Gal Hand wash <br />Wastemotet Conta.mer <br />.5.mtzc .• <br />tiearP 8, vmler lilt <br />V1.1.,g a prp Ow, <br />( <br />Booth must be on <br />Concrete, Asphalt <br />Plywood or a Tarp <br />SAN JOAQUIN Environmental Health Department <br />10 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 ElILt_efrigerator <br />0 Refngerated truck 2.-Ice bath and tubs <br />0 Other (specify) <br />lal-providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Li Three compartment sink <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 />CI Detergent, bleach, and wiping cloths (cleaning towels). <br />fl 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 />0 Water supply dispenser with warm water at a minimum of 100°F (Le 5-20 gallon container with spigot). <br />."12rOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />El Paper towels and pump-style soap container <br />Names of response persons to be present in booth during all hours of operation• <br />/VA ft-A/P-40 emr-fe--1_ <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 ration. Return original to festival coordinator three weeks prior to <br />this event. <br />Completed by <br />Signature <br />OR <br /> <br />IVIVY,Plft C.V.• <br /> <br />Title lata <br />L <br />1868 E Hazelton Avenue I <br />tit) IC•02 <br />MViSki2013 <br />Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />Page 8 of 11 TEMP EVENT APP