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1 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />1 <br />12. <br />fl Water supply dispenser with warm water at a minimum of 10O’F (i.e. 5-20 gaiion container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Completed by:14.7 Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleadiPropane Stove <br />lPropane Tank <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11 <br />Stemo wiChaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Ctxildii tor <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 metres off of the ground! <br />Extra <br />Water <br /> 5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420] F 209 464-0138 ] www.sjgov.org/ehd <br />EHD16-02 PageSofll TEMPEVENTAI <br />06/29/2023 <br />4^7 <br />Ice Cooler I <br />1 >/T <br />"Title Date <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 />^'Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Ana V) i <br />“Important** <br />zfeLJiH <br />> A SAN JOAQUIN <br />------COUNTY— <br />. Greatne?1: grc-.'S <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 /> Ice chests Refrigerator <br /> Refrigerated truck JSJ06 bath and 1111)5 <br /> Other (specify) ______ _ <br />Names of responsible persons to be present in booth during all hours of operation: <br />J - <br />, KIaACvi , _______________________________ <br />All foci 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 priorjo <br />th iseyen^ <br />777 <br />Soap and Water Rinse Water