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10. <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 100°F (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 />14. <br />Date <br />Paper Hsna To*e4s <br />Soap dispenser <br />Cuteng Board <br />Propane Slows <br />r <br />Propane Tank <br />Sriadt and WaterRinse Viale.'Scsp and Water <br />Fins tUmqu.sner <br />Ice Cooler <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day. maintain below 41 °F temperature): <br />(3 Ice chests Refrigerator <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 />£3 Three compartment sink. <br /> 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />O 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 />5 Gal liana wash <br />Waste-waiw Container <br />Garbage <br />Can <br />Boath must De on <br />Concrete. Asphalt <br />Plywood, or a Tarp. <br />5-Z0 Gal <br />Hard wash Water <br />SloTrj urfCbaiTlhg <br />Dun <br />bleadi S water for <br />Snring wiping cfelhs <br />I Extra \ <br />Water I <br />‘‘Important** <br />X-/n I 1 J XJ r\ V I I x <br />COUN’Y------ <br />Names of responsible persons to be present in booth during all hours of operation: <br />o f\ K 4 ______________ <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 . j <br />Completed by: __by W / <br />Signature <br />xrerEESggrerTsgMr WgggBSWWMWMRt’W <br />Gt'ra fca Bl-os g. Fcxxl Can:dinars mst bo I <br />storetf 6 i<wt»s off oltne grourKi! L <br />1868 E. Hazelton Avenue | Stockton, California 95205 j T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/29/2023 <br />O /C> <br />Title <br />BHealth Permit -