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Health DepartmentEnvironment <br />11.1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />OR <br />12.1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with <br />spigot). One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: Amin <br />5-20 Gal. <br />Health Permit <br />Soap dispenser <br />Cutting Board <br />Paper Hand Towels <br />Propane Tank <br />Soap and Water Rinse Water <br />Fire Extinguisher <br />Extra <br />Ice Cooler <br />10.1 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 Refrigerator <br />Refrigerated truck Ice bath and tubs <br />Other (specify)NA_Chardonnay hall <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 />Signature <br />Amin Mozeb Date 5/11/24 <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 />Eitra Ice Begs 4 Food Containers <br />must be stored 6 inches off of the <br />ground! <br />5 Gal Hand wash Wastewater <br />Container <br />Bleach <br />Propane Stove <br />Slerno w/jyjgfjijg Dish <br />Hand wash Water <br />Water <br />Bleach and Water <br />Garbage Can <br />SAN JOAr IN <br />COU N”v <br />•Important** All food vendor booths are subject to inspection. Please make a copy of this application in preparation for <br />this event. A copy of this checklist must be in the booth at all hours of preparation and operation. Return original to <br />festival coordinator three weeks prior to this event. <br />14. Completed by: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd ehd