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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />(3 Water supply dispenser with warm water at a minimum of 10O°F (i.e 5-20 gallon container with spigot) <br />K) One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />"Important** <br />Completed by: 14.o Signature <br />Health Permit <br />Paper Hand Towels <br />5 <br />Propane Tank <br />i <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 />I5j Ice chests [8 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />O Other (specify) _____________________________________________________________ <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 />5 Gal Hand wash <br />Wastewater Ccntamer <br />Garbage <br />Car. <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />Names of responsible persons to be present in booth during all hours of operation: <br />Slemo w/Chaffmg <br />Dish <br />5-20 Gai <br />Hand wash Waler <br />SAN JOAQUIN <br />-COUNTY <br />Santizer bucket <br />blearh & water fcr <br />c-nring wt->AQ noth* <br />Exira Ico Bags A Food Containers must be <br />stored 6 mc/ies off <J the grcrjnd' <br />Title <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/29/2023 <br />Kl 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 />S’ Detergent, bleach, and wiping cloths (cleaning towels). <br />H Tub to store wiping cloths In bleach solution. <br />|__| FtfeCxinawiher | <br />LaT <br />Ice Cooler | ] <br />I Soap dtspensar <br />, T~ <br />Soap and Waiv <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/x <br /> <br />Date <br />r <br />Rirse Water I I B each and Water <br />Outing Board