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Aug. 1 1. 202 1 5:23PM No. 0323 P. 4 <br />Environmental Health Department <br />11. <br />OR <br />12. <br />S^A/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />Important** <br />14.Completed by; <br />Title <br />Health Permit <br />Paper Hand Towels <br />So sp dispenser <br />Culling 0o8nl <br />Bleachpropana Sieve <br />;lPropane Tank <br />e I Bach and Waler <br />Fire Exllnflulaher <br />Ice Cooler <br />I <br />Soap and Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />Yoana Throne, Marvin Williamson, Ben Keller, Tim Ng, Linda Wilcox, and Harold Reich <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />Exira <br />Waler <br />5 Gal Hand wash <br />Was lew alar Container <br />E-2D Gb|, <br />Hand wash Waler <br />Garbage <br />Can <br />Sanlllzer buckel- <br />bleach & waler for <br />Bloilng wiping cloths <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />■STpaper towels and pump-style soap container. <br />Slomow/Chafflng <br />Olsh <br />Rinse Waler <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />soUjtion (one tablespoon of bleach per gallon of water). <br />"M Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />(ft <br />SANJOAQUIN <br />—' COUNT Y----- <br />Greotness r/rows 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 M Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />8/11/2021 <br />Date <br />----------------------\ <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 /> Three compartment sink. <br />Signature <br />Extra Ice Begs & Pood Containers mual be ■ <br />stored 6 tn ches off of th e groundl B <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 8 of 11 TEMP EVENT APP <br />Received Time Aug. 11, 2021 5:11PM No. 6857 <br />r. • M ff-’w . <br />10.