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Fire &lingo sher <br />Ice Cooler 5 Gal Hand wash <br />Wastewater Container Extra Ice Bags 6 Food Containers must be <br />stored 6 Inches off of the ground! <br />subject to inspection. Please make a copy of this application in <br />A copy • this checklist must be in the booth at all hours of <br />Retu ori.inal to festival coordinator three weeks prior to <br />tie Date <br />**Important** All fo <br />prep <br />prep ration <br />this event <br />ndor boo <br />ration for thi, <br />s a <br />event. <br />ration <br />Completed by: <br />Signat <br />Health Permit <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Sterna w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Soap dispenser <br />Rinse Water Bleach and Water Soap and Water <br />Paper Hand Towels <br />Sanitaer bucket- <br />bleach & water for <br />storing wiping cloths <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAQUIN <br /> Environmental Health Department <br />COUNTY <br />Greatness gross here.. <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 />Ea Ice chests <br />E1 Refrigerated truck <br />El Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food <br />CI Three compartment sink. <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for <br />solution (one tablespoon of bleach per gallon of water). <br />IQ Detergent, bleach, and wiping cloths (cleaning towels). <br />Pi 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 (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />T Na es of responsiblepersons to be present in booth dunmq all hours of operation: <br />./Ori 1(1 VIA J AV %RA, (fiMuil{i 1111(A- 1 <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 />CHO 16-02 Page 8 of 11 TEMP EVENT APP <br />06/29/2023 <br />El Refrigerator <br />0 Ice bath and tubs <br />OR <br />preparation utensil <br />rinsing and one for a bleach