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10. <br />11.I ai <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 />£Completed by: 14. <br />Signature <br />Pepsr Hjr.c Towcts <br />Soap dispenser <br />Cultse BoarS <br />Prapaos Sim's <br />Prawns Tank <br />BiearSi and Waiw <br />rite Ext>r*JU-ih« <br />TEMP EVENT APP <br />zG <br />Ice Cooler <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 dazjnaintain below 41 °F temperature): <br />0lce chests ZflRefrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <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 />jrproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />5 Gal Ha-ic wash <br />Wasteadtef Oerrtair^r <br />5-20 Gal. <br />Hani wash water <br />Garbage <br />Can <br />Ssnitirer txrsket- <br />4 water far <br />Storing wipng cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Stemo wuchatring <br />Dish <br />• - <br />Health Permit <br />&rn» Jcp £ Fas^ Ccxdancra pr.-ai be <br />dtxxfd 5 farfies at of ItgrouadJ <br />Date <br />L <br />Soap sne Water Rmsc Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />K <br />f] <br />‘‘Important** <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHO 16-02 Page 8 of 11 TZt.tP tZVEJiT .*J <br />06/29*2023 <br />\^nii j x-r m <-» i i » <br />-COUNTY----- <br />y -- ' <br />Title <br />4^ <br />_________------------------------ <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