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10. <br />11. <br />OR <br />12. <br />0 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 />Signature <br />Health Permit <br />Paper Hand Toweta <br />Saap drsperisar <br />Culrinq Banrri <br />BleachPropane Stove <br />n 3 <br />Propane Tar* <br />Fire E» tiuqus«>er <br />Ice Cooler <br />TEMP EVENT APP <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 /> 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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />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 /> Ice chests Refrigerator <br /> Refrigerated truck 0 Ice bath and tubs <br /> Other (specify) <br />Exfrp Ico Rury; X Fond Canloirxns must bn <br />6 rncbos ol/olthe ground! <br />Stenvj w^ChaRing <br />OUi <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />S Gal Haixl wash <br />Wirtlnwatnr Container <br />Santiror buctat- <br />tleat.li 6 v.u(er far <br />minting wp'ng doth:; <br />5-20 Gal. <br />Hrsnd wash Wotcr <br />Title <br />Rnw WtrUrr <br />Date <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. zp <br />Completed by: /U tJ <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/chd <br />El <O 16-02 Page 8 of 11 ““JT A! <br />0fi/29/2023 <br />vmi urny v i i i <br />COUNTY <br />Names of responsible persons to be present in booth during all hours of operation: <br />irlcr^ "Z ____ ___________________ <br />** Important** <br /> c2Fl I <br />I <br />Sojp and Waler