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I <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />13. <br />In-ifn ' <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />‘LXJ <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APP <br />J <br />Soap and Water <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 Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />71 <br />Ice Cooler I <br />IF <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows 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 />□ Ice chests IX[ Refrigerator <br />EQ Refrigerated truck 0 Ice bath and tubs <br />□ Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT A! <br />07/01/2024 <br />IF LI <br />Rinse Water <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 />S 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 />bootb: hxnct 5(rA< \o\Vn M unkr, scop, pcgxr- <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Names of responsible persons to be present in booth during all hours of operation: <br />Edec Rer>(joH) H u ottocr-t?) ne Gutyv. Oscccr ; U i QfW-At? <br />‘‘Important** 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 />x WhzS IW (Vt/v/c <br />J signature Title