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iLn i <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />iPropane Stove <br />0it <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <br />J <br />Extra lea Bags & Food Containers must ba <br />ttorsd 6 mebej off of the ground! <br />Sleroo WChaffing <br />Dish <br />Exira <br />Water <br />Garbage <br />Can <br />San'iiznr buckel- <br />bteach & water for <br />9lonn« wipiftfl cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Title <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />'0'water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot) <br />r <br />Soap and waler <br />r <br />Rinse Water <br />Environments^ Hesith iLeparimer.: <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> ^Jz^aper towels and pump-style soap container. <br />Namesof responsible persons to be present in booth during all hours of operation: <br />Ail 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 /> <br />Signature Title I Dare <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 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 />D'fee chests ^Refrigerator <br />□ Refrigerated truck Q Ice bath and tubs <br />□ Other (specify)_____________________________________________________________ <br />Soap dispenser j <br />O^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 />i0Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />| aieech <br />1888 f, Hazelton Aver.ua Stockton, California 95205 | T 209 468-3420 | " 209 464-0138 | wwv.'.sjco. <br />EHD 16-02 Page 8 cf 11 TEMP EVEN <br />Cullnq Board