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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />K] One separate tub (bucket or basin) for the collection of rinse/wastewater <br />B Paper towels and purr soap container. <br />13. <br />“Important** <br />Completed by:14. <br />Health Permit <br />Paper Hand Toweh <br />Cuttng Board <br />BteacfiPropane Stove <br />I <br />Propane Tank <br />Rroe Water <br />Fire Extinguisher <br />Ice Cooler <br />Stemo wfChoffing <br />Dish <br />5 Gai Hand wash <br />Wastewater Container <br />5-20 Gai. <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Senitizerbucket- <br />bteach & water for <br />storing wiping doths <br />Nam^of res^jj^s^te^rsons to be present in booth during all hours of operation: <br />4/16/2023 <br />Date <br />SAN JOAQUIN <br />-----COUNTY------ <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 />[3 Ice chests Refrigerator <br /> Refrigerated buck ® Ice bath and tubs <br /> Other (specify) <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />_____________/ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD1&02 Page 8 Of 11 TEMPEVENTAPP <br />06/1W19 <br />| Soep 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 />S 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 />K Detergent, bleach, and wiping cloths (cleaning towels). <br />® Tub to store wiping cloths in bleach solution. <br />Ail 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 /> Owner <br />Signature Title <br />I Extra Bagt & Food Containers must be ■ <br />I stored S Mies off of tfie ground! B <br />I Soap dispenser <br />Garbage <br />Can