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1 'AiA'- <br />Environmental Health Department <br />a <br />10. <br />11. <br />OR <br />I ■ <br />12. <br />13. <br />14. <br />Date77Signature <br />| Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BieachPropane Stave <br />Propane Tank <br />Fire Extinguisher <br />Ice Cooler ? <br />F <br />TEMP EVENT APP <br />Stemow'Chaffing <br />Dish <br />5 Gaf Hand wash <br />Wastewater Container <br />5-20 Gat. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />^3 Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping ctoths <br />\ -u. t <br />0 <br />^Important** <br />y extra fce Bags <5 Food Confaffters must be <br />.......... i iimii . sliced G indias off of Uta fffotfftd! <br />_ n ___ <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD16-02 Page 8 of 11 TEMP EVENT A! <br />06/29/2023 <br />------------IS <br />I Soap and Water <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 6-8 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 />O Detergent, bleach, and wiping cloths (deaning towels). <br />O Tub to store wiping doths in bleach solution. <br />SAN JOAQUIN <br />------COUNTY------- <br />G r e o t n c 5 s ci ro t- y .? !; e; ’ t;- <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 />fSdce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___________ _______________ ____ <br />51 Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />X CtooX s - ______________ _____ <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. , y/^// <br />Completed by: <br />: Title Date