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Environmental Health Department <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />O^aper towels and pump-style soap container. <br />13. <br />Completed by:14.v <br />Date' <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />_K_ <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher0 <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />J <br />Soap and Water <br />z <br />Rinse Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo 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 (or <br />stonng wiping cloths <br /> Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gai. <br />Hand wash Water <br />( 5^) %O -53'0 <br />// <br />Signature <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 />ETDetergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />SANJOAOUIN <br />- rnk.4 ------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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ _ _______________ _____ <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />Title <br />10. <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 Al <br />AC/AA/OAOO <br />Names of responsible persons to be present in bpoth during all hours of operation <br />‘‘Important** All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. <br />preparation and operation. <br />this evertf^---7<^^