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J ; A 10. <br />V\:Pk 11. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />A 12. <br />|K) Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[S] Ono separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Completed by: 14. <br />Date <br />Health Permit I[Paper Hand TovnMs <br />Soap rlis'jens'.’i <br />BluacliPropane Stove <br />(u <br />Propane Tank <br />Bleach and V>'a!er <br />Ice Cooler <br />TEMP BOTT 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 />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 />f*] Ice chests Refrigerator <br />|H] Refrigerated truck Ice ball) and tubs <br />[k| Other (specify)______________ <br />5 G3» Hand wash <br />Wastev.-aler Contem.er <br />Garbage <br />Can <br />Sanilr/er Urickul <br />blrach A waler for <br />staring wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br /> Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary'cleaning of food preparation utensil <br /> Throe compartment sink. <br />Steino wfChufiTny <br />D>5h <br />5-20 Gal <br />I land wash Wulei <br />SAN JOAQUIN <br />COU*'-."V- - • <br />Fire Exlingjishw | <br />Er'JV Ice Bsfls f. Food Ccntnincrs wk! be <br />stated 6 hebas c!1 of the ground! <br /> Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />O Tub to store wiping cloltis in bleach solution. <br />_z <br />Soap and Water <br />'Av'AVlh .e'. <br />Signature <br />Rlnseater <br />. 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Q-,-_______ _ ___________ ________ __ <br />f \ kJ,■VkC).^ <br />Title <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 />this event. <br />Ml <br />b1 <br />1868 F Haznlton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 I VAYW.sjgov.org/ehd <br />EHOTG^Z Page 8 of 11 TEMP EVENT A! <br />Ou/19/19 <br />Cu.tJnri Rnr.nl