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10. <br />11. <br />OR <br />12. <br />13. <br />A copy of this checklist must be in the booth at all hours of <br />Completed by:14. <br />I <br />Health Permit <br />I <br />Hand ToA-is <br />Soap dispenser <br />CuUsxj Board <br />Propane Slavs <br />$ <br />PreoancTank <br />Blrjsch and WaterRinse WaterSow> and W&fst <br />Few t-xtnKjuhiher <br />T£MP EVENT APRPage 8 of 11 <br />z. <br />Ice Cooler <br />Extra <br />Vfxer <br />5-20 Gal. <br />Hand wssn Water <br />5l«rno vtfCtutffing <br />Dish <br />5 Gal Hand wash <br />VVaSra-tcr Container <br />Sani liter bucXet- <br />Meaii & water For <br />sioing wising doth® <br />w rt i i J vj n <br />-----COUN" <br />Title <br />p»s=8»3WWgai>^ <br />tee Sags A Food Corrtsiwrs musr tie <br />doted S iKtes effoftne gmmcl! <br />Date <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />I _________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />a <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />-03-Water supply dispenser with warm water at a minimum of lOO’F (i.e. 5-20 gallon container with spigot). <br />Garbage <br />Can <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 />Sy Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | ^-sigoyWehd <br />EHO 16-02 p*je 8 of 11 SVENT A1 <br />06/29/2023 <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 />f^ljce chests O Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).,—---------------------------------------------------------------- <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />■Q Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____________________________________ <br />r VkPS UA1 re MAA k£ 1 -. <br />’Important** All food vendor booths are subject to inspection. Please make a copy of this application iri <br />preparation for this event, j . __rz <br />preparation and operation. Return original to festival coordinator three weeks prior to <br /> <br /> <br />7 Signature