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Docusign Envelope ID: FCB4E7EA-D3D1-48B0-BC03-D00GB1266283 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[x] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H One separate tub (bucket or basin) for the collection of rinso/wastcwatcr. <br />[x] Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Owner 4/15/2025Completed by.{14. <br />Title DateSignature <br />Health Permit <br />Paper Hand Towds <br />(UeadiPropare Stove <br />0 <br />Prooano Tank <br />Firo I jdinguishcr <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach A water lor <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />”1" <br />'4 <br />Extra <br />Water <br />Slcrno wrChaffing <br />Osh <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />C ( .■ I. '■ <br />l.xtni icc Hags A f ood Conlatnors most be <br />stored 6 inches otf of the ground! <br />Names of responsible persons to be present in booth during all hours of operation: <br />Tomeako Honesto <br />[x| 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 />[xj Detergent, bleach, and wiping cloths (cleaning towels). <br />[xl Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[J Three compartment sink. <br />J <br />Soap and Water Garbage <br />Can <br />IT L <br />Rinse 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 />.. .this event <br />____ <br />j j Bleach and Water J l <br />1068 li. I lazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464 0138 | www.sjcelid.corn <br />tl ID 16 02 Pago 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Soap dispenser | <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 />[xj Ice chests LJ Refrigerator <br />□ Refrigerated truck H Icc bath and tubs <br />□ Other (specify). ICC chcsC <br />Cutting Board