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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 />O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />••Important** <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Tcm*3 <br />Soap diapensar <br />Prrpane Stove <br />0JJ <br />Propane Tank <br />CJI Rmw Water Bleach and Water <br />Ftro Ejdmotearaer <br />Ice Cooler <br />Exira <br />Water <br />SanArw txx*a; <br />txaacn 1 water for <br />storirvj wipwig OoVte <br />EHD 18-02 <br />07/01/2024 <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 <br />this event. <br />Stamo wChafling <br />Drat' <br />5 Gal Haro wav- <br />Wavirwater Container <br />5-20 Gai <br />Handwash Water <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />Garbage <br />Can <br />SAN JOAOUIN <br />COUN'Y <br />ration. Return original to festival coordinator three weeks prior to <br /> <br />DateTitle <br />1 <br />Soap and W«te> <br />^Paper towels and pump-style soap container. <br />CuKig Soard ______ <br />EiTra lea 8ag> A Food Contamn mM be <br />Blared 6 rK/wi off a! Pie grvjnd' <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />"^3-Jhree 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 />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 /> Ice chests Refrigerator <br />{Refrigerated truck ice bath and tubs <br /> Other (specify)_____ ___________________________________________________ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www sjgov.org/ehd <br />E.HD 15 02 p,oe 8 or 11 IE MP EVENT APP <br />Names of rpsponsiblepersons to be present in booth during all hours of operation: