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Environmental Health Department■> <br />10. <br />11. <br />OR <br />NK 12. <br />B Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gaHon container with spigot). <br />B One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towafc <br />Cuffing Board <br />Propane Stoee <br />I I <br />Propane Tank <br />TEMP EVENT APPPage 6 of 11 <br />ka Bagt t Food CoatBinan iwa to <br />atom! 8 odo! {^ouaff <br />Stats WChattng <br />Efch <br />>20 Gai. <br />Hand assh Water <br />Sandtoer budtH- <br />bteochS anta for <br />tanagteptegdota <br />1 <br />Soap and Water <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 />5 Gal Hand wash <br />Garbage <br />Can <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Z______ <br />Ice Cooler <br />I Beach <br />J Soapdtepensa I <br />0 <br />Title <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />_____________/ <br />Names of responsible persons to be present in booth during aH hours of operation: <br />&Wso»"s. —__________________—--------------------------- <br />Ik) X > \ \q ________ —---------------- <br />**lmportant" <br />I <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | ^•si9OVp°f^^1 <br />EHD1MJ2 PageBcfll TEMPEVENTAI <br />06/19/19 <br />SANJOAOUIN <br />-----COUNTY------ <br />Gr<?otnr’S$ grotvs here. <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 />B Ice chests O Refrigerator <br />B Refrigerated truck Ice bath and tubs <br />H Other (specify) ——---------------------------------------------------------- <br />AS food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event A copy of this checkfist must be in the booth at aH hours of <br />preparation and operation. Return oriqtoai to festival coordinator three weeks prior to <br />this event. . x-------- 7- <br />DateSignature <br />Are Extingustar j <br />I J EteaciiandWata <br />0