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imageO.jpeg• 10/3/25, 1:27 PM <br />Environmental Health Department <br />10. <br />ii. <br />OR <br />12. <br />n Water supply dispenser with warm water at a minimum of 100°F (Le. 5-20 gallon container with spigot). <br />S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />® Paper towels and pump-style soap container. <br />13. <br />‘•Important** <br /> <br />Title <br />Completed by: 14.Signature <br />Health Permit <br />Paper Hand Towsts <br />CuMino Board <br />Prwano Stowe <br />Propane Tv* <br />aaachaadW^ <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209464-0138 | www.sjgov.org/ehd <br />1/1httpsV/mail.google.com/mail/u/3/#inbox?projecton=1 <br />■ • " fi IIce Cooler > ; <br />I am providing the foilowing for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />SVMltzerbuckat- <br />btoacb&water far <br />■tortas vdptas ttotea <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 />S Deteigent, bleach, and wiping cloths (cleaning towels). <br />O Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />MANJEET SINGH <br />Stemo WCMteg <br />Dish <br />S Gai Hand wash <br />WnrtsaurCiniiWnar <br />Garbage <br />Can <br /> Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />SANJOAOUIN <br />-----COUNTY----- <br />A <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compavtment sink. <br />T <br />Soap and VMar <br />I Bleach <br />09/25/2025 <br />Date <br />550 Gal <br />H—dWlhWlter <br />I am providing the foltowing cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 °F temperature): <br />0 Ice chests Refrigerator <br />Q Refrigerated truck Ice bath and tubs <br />Q Other (specify)_ _____ <br />AH 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 />*W«d0»K*MOftfifN0roiM« M <br />I Soap dtapenser <br />I Rtota Water <br />HreedtWMtehv |