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1 <br />DocuSign Envelope ID; B51580D3-C4C3-4BC8-8670-6D343266EAC8 <br />I <br />Environmental Health Department <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />!Darrel Ayers <br />Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />u <br />Propane Tank <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <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 />0 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 />booth: <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />0 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 />this event <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />Sanitizer bucket­ <br />bleach & water tor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp <br />I <br />I <br />f' i <br />Stemo w/Chaffing <br />Dish <br />Garbage <br />Car <br />Ice Cooler <br />_________I/ <br />Darrel Ayers <br />Title <br />0 Paper towels and pump-style soap container. <br />i ] Names of responsible persons to be present in booth during all hours of operation: <br />C ] I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />**lmportant** <br />4/10/2019 <br />Date <br />-----DocuSiontd by: <br />^-Signatwe242o... <br />Cutting Board <br />Extra Ico Bags & Food Containers must be M <br />stored 6 Inches off of the groundl <br />S4NJOAOUIN <br />UnV'J -----COUNTY----- <br />\ Fisr^rr j <br />Greatness grows here. <br />( ''] lam providing the following cold temperature control for the cold holding of potentially hazardous foods below