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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />O’One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />•‘Important** <br />this event.06-20-2023CEO14.Completed by: <br />Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Slove <br />u 3: <br />Rinse Waler Bleach and Water <br />Fire ExtinguisherQ <br />Ice Cooler <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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Extra fce Bags i Food Containers must be <br />stored 6 inches oH ol the ground' <br />Slerno w/Chafting <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br />Sanitizer buckel- <br />Bleach & water lor <br />storing wping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />Name^ of^re§ponsit)|le persons to be present in booth during all hours of operation: <br />Samantha (Juk <br />Propane Tank <br />/ <br />_z <br />Soap and Water <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 />oSignfld via S«aml«MDoc«.ecffl <br />*" Kay. 3e31 •dfAdWcifadl •7&ac31 •7d04a4a <br />SAOAOUIN <br />------COUNTY------ <br />Greatness grows 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 />0 Ice chests Refrigerator <br /> Refrigerated truck O’ Ice bath and tubs <br /> Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 8 of 11 TEMP EVENT APP <br />06/19/19