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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />•‘Important** <br />Completed by: 14. <br />Title DateSignature <br />P*pct 3 Toat x <br />Sop diweiMS <br />CwRi-g Bojic <br />B eachPtcparc Stove <br />OLkJLI <br />Prcwe Tank <br />Bleach ano Wat« <br />Pre F >t ejuiahw <br />Ice Cooler J <br />TEMP EVENT APP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Band M>»h <br />Wacsewaler Ccnia n-- <br />Garbagc <br />Can <br />Santiet tucket <br />bloach J. wi'ei fc’ <br />’ir- ni] A’Ctnfl Clcthx <br />(_] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />LifOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Eitra Ice &>J3 4 fcod Ccr.taneri must t*’ <br />Stored fi of o' !'<• (j/ou'Xl' <br />Stemo ttfCha*fing <br />D xb. <br />5-20 Gal <br />Hard Watot <br />Booir- must t>? on <br />Concrete, Asphalt <br />Plywood or a Tarp <br />Health Permit <br />z <br />Smp and Watw <br />7 <br />R nse Walci <br />O Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sol^iron (one tablespoon of bleach per gallon of water). <br />CTbetergent, bleach, and wiping cloths (cleaning towels). <br />Cj Tub to store wiping cloths in bleach solution. <br />Q'Paper towels and pump-style soap container. <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | vavw <br />EHO 16-02 P<ig*> fl of 11 TEMP EVEN.. - <br />07,■01/2024 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink <br />Namps of responsible persons to be present in booth during all hours of operation: <br />/h 1V _________________ <br />^7 r s;, /z______________________________________________________________ <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 />SANJOAOUIN <br />------COUNTY------- <br />Crcotnen growl 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 />QZlce chests Refrigerator <br /> Refrigerated truck Q^ce bath and tubs <br /> Other (specify)__________________________________________________________ <br />E*Va <br />Walt*