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Environmental Health Department <br />10. <br />11. <br />OR <br />I <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />P^| One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />14.Completed by: <br />ate <br />Paper Karn Tcnvets <br />Cut^npBosni 1FrOMoe Stove <br />u u <br />ftrcsne Taifc <br />Rinse Wetar <br />Fire <br />Ice Cooler ' < <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tubs (basins 6-3 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 />Q Detergent, bleach, and wiping cioths (cleaning towels). <br />5^Tub to store wiping doths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SGsiHsadvesh <br />WssknesbM CcoSasw <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />it <br />Erfra Sags S Foot) Coniaiwrs jsutf te <br />sixed 6 sKtias aS al ftw grownJJ <br />SsnEzer buefcet- <br />MaacTiS water for <br />storing wofcg doQts <br />Stems WChaSng <br />Otsh <br />- SAN JOAQUIN <br />------COUNTY------- <br />I am providing foe 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 410F temperature): <br />0 Ice chests d Refrigerator <br /> Refrigerated truck Ice bath and fobs <br />p^J Other fsoedlv) P.Qo\CX.^__ _____________________ <br />"Important** <br />_L <br />Sonp and Watet <br />Health Permit . i <br />Paper towels and pump-style soap container. <br />Names of responsibfejiersons to be present in booth during all hours of operation: A <br /> <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 foe booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this evepfe—> f p 1 A i . <br />_______(Yfyner H 1 ^7 <br />Title Date ’ <br />1668 E. Hazelton Avenue [ Stockton, California 95205 | T 209 468-34201 F 209 464-0138 ] www.sjgov.org/ehd <br />Erlpisei PageSolll TEMP EVENT APP <br />06f2fi^23 <br />5-3D CM. <br />y* Water <br />Soap ffipfinss I \ <br />Signature