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Environmenta Health Department <br />10. <br />11 <br />OR <br />12.I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: <br />13. <br />14.Completed by: <br />SfgjYsrfure <br />1 Paper Hand Towels <br />Bleach <br />Prooune Tank <br />Fire Extinguisher <br />Ice Cooler <br />EHD 16 0? <br />06/29/2023 <br />5 Go! Hand wash <br />VVnsiowolcr Containdr <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & watnr Tor <br />storng wiping cIc’Jis <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Extta tea ffa 4 t-'-.aii Ccntomcrs must be <br />stored 6 "it oV '.f Ihs ground* <br />Sterna w/Chaffing <br />Dish <br />Qi/orur" <br />Title <br />——— <br />SAN JOAQUIN <br />''ou: it t" <br />-J <br />5-20 Gal. <br />Hand wash Water <br />^Pv'Vater supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />'p^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />| P/opane Stove <br />I Cwtlinq Board <br />Health Permit | <br />7 <br />Rinse Water <br />d 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 />n Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />lam providing the following items within my booth for the sanitary pleaning of food preparation utensil <br />fhree compartment sink. <br />'pf’aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hobrs of operation; . <br /> J ‘Sar?7tgV\7 <br />AfrjL on I u 1 <br />Important** AlTfood vendor bJoths are subject to inspectiojn. 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. I i <br />| Soap digpenser | <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 6 of 11 TEMP EVENT APR <br />' the followin9 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 />^©’icc chests Refrigerator <br />D Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />LZ <br />Soap and Water Xi- <br />Bleach and Water <br />I Extra <br />Water