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i <br />1(1 <br />11 <br />OR <br />12. <br />13. <br />**lmportant** <br />Completed by: 14. <br />f’aotf Hand Towol» <br />Soap disi’W’snr <br />CiiKing Brwrd <br />■ <br />(iinach <br />F’ropano Slow <br />Propnno lank <br />Tiro Exlinonifino' <br />Ice Cooler <br />Page 8 o( 11 <br />w <br />I ttm fco A’affS * > <•<«' Conltitiitim tnusl ha <br />Morr't/ 6 mchos ollolthn <br />Stemo w/Chahuri <br />Exira <br />Walnr <br />5 Gal Hand wash <br />WiKWwalcr Container <br />Sanitizer buckel- <br />Meach S walor for <br />stonng wioing doih» <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />I am p— • <br />45nF (if food it <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br /> <br />i <br />SAN JOAQUIN <br />' C O (J N T Y .. <br />Title <br />1 <br />Soap and Walor Rinsn Wnlar <br />1868 E. Hazelton Avenue | Stockton, California 95205J 1^209 468-3420 | F 209 464-0138 | <br />EHD 16-02 (’n'V' 1 <br />07/01/2024 <br />Environmental Health Depart <br />□ Water supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br />l^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Providing the follov— • ■ <br />. is iisnrt ihr, i H x.vihhh hji me coiu noiumy u• ed the following day. maintain below 41T temperature): <br />LI Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Haixl wash Walor <br />BUarh □nd Walor I " <br />__________J I Garbage <br />_ ___ I Can <br />utensil wash within myboothPr°Vldinq ,,1C followinq for ado,ltJat« hand washing facilities, but separate from <br />^,|n9 cnld temperature control for the cold holding of potentially hazard <br />LI Three co'mn^rt followin9 '’‘-ms within my booth for the sanitary cleaning of food preparation utens' <br />i nree compartment sink <br />^ohitim?/rfl<'(|P.,lJbR 6-8 inches minimum), one for soapy water, one for rinsing and one fo <br />. ??Iespoon Of blGach P0r ga'lon of waler). <br />^uetergent, bleach, and wipmg cloths (cleaning towels) <br />LJ tub to store wiping cloths in bleach solution <br />Names of responsible persons to be present in booth during all hours of operation: <br />Pvt _____________ ______________________________— <br /> <br />All food vendor booths arc 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. . I / <br /> <br />Signature Title Date <br />_ ____I----- <br />Health Permit J'