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Environmental Health Department <br />10. <br />larjxproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />[y Three compartment sink. <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 />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Nai13. <br />-Important** <br />Completed by:14. <br />Z Signature <br />Health Permit <br />PK* Hwd TowW« <br />CutlnaBoanl <br />PropvwStov* <br />I <br />I ProoMwTmk <br />Bleat* and Wear <br />Ice Cooler <br />TEMP EVENT APP <br />Etfa lea Bao> < Food Cortfaheri nut be <br />itond a hd»« o/T of Ibe gmng <br />5-20 Gal. <br />Hand «Mti Watar <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />iir^o^sp^nsi^le^^o^to be^^^^hbooth^uro^alll^hoyrs of operation: <br />Slamo WOiafflno <br />5 Gal Hand wort <br />Wauewalw Container <br />Cartage <br />Can <br />SarXaarburtat- <br />bleart t waur lor <br />BtodnQ wiping detfn <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp- <br />I Soao diipantar <br />2 <br />Soap and Waler <br />rzl <br />Rktae Water <br />SANJOAQUIN <br />* ------COUNTY------ <br />Greotacrs jrov/s 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^jnaintain below 41*F temperature): <br /> Ice chests [^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)______________________________________________________ <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 />!6“ <br />Title Date <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 />1868 E. Hazelton Avenue I Stockton. California 952051 T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pajd 8 ol 11 ■*-' <br />06^9/2023 <br />L- [ FWE^rtW ~|