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I <br />Environmental Health Department <br />10. <br />11. <br />OR <br />I <br />12. <br />13. <br />Completed by:14. <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />Fire Extinguisher <br />Ice Cooler [ | <br />TEMP EVENT APPPage 8 of 11 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Stemo vrfChaffing <br />Dish <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gai Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand washWater <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />^X^Qne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^^Paoer towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Date <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />Sution (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />**0 Tub to store wiping cloths in bleach solution. <br />**lmportant** <br />>SAN JOAOUIN <br />' ------COUNTY------ <br />.. Greatness fir-.s.ys her?;. <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 />M Ice chests Refrigerator <br /> Refrigerated truck pf Ice bath and tubs <br /> Other (specify)____________________________ ____:--------------------------------—— ----------------------- <br />Health Permit a <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 />preaaration and operation. Return original to festival coordinator three weeks prior to <br />Extra Ice Bags & Food Containets must be > <br />stored 6 defies off of the gmumt! i,___________ <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | ^■sj9o/rooJ9^hd <br />EHD 16-02 Page 8 of 11 TEMP EVENT Al <br />06/29/2023 <br />Soap and Water Rinse Water