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Title Date Signature <br />Health Permit <br />5-20 Gal. <br />Hand wash Water <br />Paper Hand Towels <br />Stereo w/Chaffing <br />Dish <br />Cutting Board <br />Propane Stove <br />Soap dispenser <br />Sanitrzer bucket- <br />bleach & water for <br />storing wiping cloths <br />Propane Tank <br />r <br />ice Cooler <br />Soap and Water <br />Fire Extinguisher <br />ill Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Bleach and Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Rinse Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN4JOAQUIN <br />COUNTY <br />GreCittless grows h e : <br />Environmental Health Department <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 />gr Ice chests 111 Refrigerator <br />'Refrigerated truck El Ice bath and tubs <br />111 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 />OR <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 />121 Detergent, bleach, and wiping cloths (cleaning towels). <br />VTub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />RiWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />RfOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth 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. 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 />Completed by: <br />1868 E. Hazelton Avenue I Stockton, Califomia 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />El-ID 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19