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SAN JOAOUIN Environmental Health Department <br />10. <br />-VxA <br />11. <br />OR <br />12. <br />Q Paper towels and pump-style soap container. <br />13. <br />'‘Important** <br />Date ' <br />14.Completed by: <br />Health Permit <br />I Paper Hani Towels <br />Soap dispenser <br />Propane Stove Bleach <br />Bleach and Wafer <br />Fire Extinguisher <br />- - . - ... - J <br />Ice Cooler <br />-V .-J .v <br />□ Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot) <br />Qj One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Sterno w/Cnaffinj <br />□ish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Conlaner <br />Garbage <br />Can <br />Sammer buOiet- <br />bteach 3. water (cr <br />storing wiping clothn <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Woter <br />9 -•'a <br />TEMP EVENT APP <br />_________ <br />Title <br />Propene Tank ___L <br />Soap and Water Rinse Waler <br />J <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />fj 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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />____________________: <br />boothPr°Vidin9 thG f0ll0W'n9 for adequate hand washing facilities, but separate from utensil wash within my <br />--------------------------------------, <br />Ex/ra Ice Bags & Food Conta/ncrs must be f <br />Stored fl inches off of the ground’ <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br />□ Ice chests <br />□ Refrigerated truck <br />C3 .Other (specify)__ <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, <br />Vx u £ <br />Signature <br />□ Refrigerator <br />□ Ice bath and tubs <br />he-ltxx) C <br />•- E Hazelton Avenue J Stockton. CaJ^omsa 952OS T 209458-2420: F 2O& 464.0 loo } <br />EHD 15-02 Page 3 of 11 <br />06/29/2023