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Environmental Health Department <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 />“Important** <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />1 <br />Propene Tank <br />Bleach and Water <br />Fire Extlnoulsher <br />G <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 items within my booth for the sanitary cleaning of food preparation utensil <br />K Three compartment sink. <br />Extra tea Bags i Food Conlelnen must be <br />tlomd 6 Inches oil ol Iho gmundl <br />Stemo w/Chatfing <br />Dish <br />SGsl Handwash <br />Wastewater Contalnar <br />Garbage <br />Can <br />Sanklrar buckel- <br />blaach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand v/ash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Signature <br />( Extra \ <br />Water <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, z-.-------- Owner 1/18/2024 <br />Title Date <br />_z <br />Soap and Waler <br />3 <br />Rinse Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />Nicole Moore <br />| Soap dispaniar [ ---------- <br />i-UOt <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT <br />07/3/17 <br />SANJOAQUIN <br />dBlV 1 -----COUNTY------ <br />''-i/ii-ov.'''7’ Gn’otncss y/ows here. <br />10. lam 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 />0 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).