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Environmental Health Department <br />10 <br />11. <br />OR <br />12 <br />E Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />“Important- <br />Completed by: 14 <br />Health Permit <br />Papw tterxJ I <br />Piopan* 9k>ve <br />I) <br />PtopacwTan* <br />)Btead< and WaterRme WaterSoa*andWttB <br />FaaEitewumhar <br />Ice Cooler <br />TEMP EVENT APP <br />Santaar bucket <br />bteadi 1 aater kx <br />vapaig cloths <br />5 Gai Hand wash <br />ytMWinter Container <br />5-X) Gai <br />ItendraMhWrtH <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SbmorOdbg <br />Ctah <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />COUNTY <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink N C - K6 I < <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 />O Tub to store wiping cloths in bleach solution. <br />I am providing the folowing cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day. maintain below 41 °F temperature): <br />Ice chests Q Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) <br />Mxadda'Kftteoffarffwp'oixid' I . <br />[4} Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />AcVteino lAarAine? ____________ ______________________________ <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 evgntr, <br />Signature Title <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwwsjgov.org/ehd <br />EHO 16-02 Page 8 oi 11 TEM? ZVE.*.T.“J <br />07/0V2O25