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to ■ <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q^A/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[ZTOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13.t in booth dunrL* <br />Completed by: 14. <br />Signature Title Date <br />Health Permit i <br />Paper Hand Towels <br /> Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />T <br />Bleach and Water <br />Fire Extinguisher <br />Rinse Water <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 inches off of the ground! <br />Sterno w/ChaffingDish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />[^ce Cooler <br />J <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/01/2024 <br />SANJOAOUIN <br />------COUNTY------- <br />Greotness 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 dayynaintain below 41 °F temperature): <br /> Ice chests Q^efrigerator / J / <br /> Refrigerated truck Ice bath and tubs I. X’"T/ \lA ] t Af / <br /> Other (specify) <br />larrTproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />Ej Three compartment sink. <br />La Tlyee deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solptiop (one tablespoon of bleach per gallon of water). <br />(Bg^tergent, bleach, and wiping cloths (cleaning towels). <br />Eknub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />\ '' if _________________________________ <br /> <br />**lmportant** 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. <br />Propane Tank----------------> <br />)