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I <br />10. <br />11. <br />OR <br />12. <br /> Water supply dispenser witti warm water at a minimum of 100oF (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 />13. <br />Important** <br />14. <br />Date <br />Paper Hand <br />Soap Cispcnscr <br />Cutlsna Board 1 BleachPropane Stove <br />nu <br />Propane Tank <br />Bioacn and WaterRinse Water <br />TEMP EVENT AFP <br />- - ■ •^control for the cold holding of potentially hazardous foods below <br />(if food is used the following day,>rrairitain below 41 °F temperature): <br />Ice chests EfRefrigerator <br /> Refrigerated truck 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 /> Three compartment sink. <br /> Three deep tubs (basins 6-3 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />5 Gal Hand wssn <br />Wastewater Ccntener <br />Garbage <br />Can <br />SsnrliTcr fcutkel- Meach a wwer <br />slorin; doths <br />Boom must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sserno »>Ch«tE*>9 <br />OiSfl <br />ins to be present in booth during all hours of operation: <br />c. < o i ______________ <br />I am providing the following cold temperatup <br />459FI <br />Names of responsible pen <br />| Ice Cooler <br />Crtrs ret? Bags 5 Feed Con!a*i«s mtzs! 09 <br />stored 6 mef^s off of tfw gnxirajr 3 <br />fitie <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. C" - r ._ 7 U <br />Completed by: -----r-------- - c- <br />Signature <br />; wnty u 1 n <br />------CC’UN~V------ <br />WO Gal. <br />Hand wash WMT <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 paS® 8 °! 11 TEMP E'/£WT — <br />(W29«2023 <br />Health Permit ’ <br />FT L_z <br />So«j and Water <br />Extra <br />Water