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Docusign Envelope ID: 9EE810EA-C48B-4043-AFC1-A908D1848E97 <br />SAN JOAQUIN 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 />(xl One separate tub (bucket or basin) for the collection of rinse/wastcwatcr. <br /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />4/15/202514. <br />Title DateSignature <br />ZHealth Permit <br />]Paper Hand Towels <br />BleachPropane Stove <br />Profiano Tank <br />Bleach and Water <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />i J Detergent, bleach, and wiping cloths (cleaning towels). <br />I 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 />LJ Three compartment sink. <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach A water for <br />storing wiping cloths <br />Slorno w/Chaffing <br />Osh <br />Extra <br />Water <br />5 Gal I land wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />. ■■ .... ... ■, I <br />Extra lec Bags S food Conlaincts must bo <br />stored 6 inches off ol (ho ground1 <br />J Soap distxinser | <br />IT LT <br />Rinse Water ]11 <br />z-x | Fire ExtinguisherIt I <br />Names of responsible persons to be present in booth during all hours of operation: <br />Abigail Tutor <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 oriciinal to festival coordinator three weeks prior to <br />...mis event. ^e,. <br />Completed by:!/,^- t <br />J <br />Soap and Waler <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 />2<J Ice chests N Refrigerator <br /> Refrigerated truck Fl Ice bath and tubs <br /> Other (specify) a"d cllests <br />3 U o <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 PagcBofll TEMP EVENT APP <br />07/3/17 <br />Booth must bo on <br />Concreto, Asphalt. , <br />Plywood, ora Tarp. | <br />Culling Board