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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Important** <br />Completed by: 14. <br />Date <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />-I I <br />1 <br />TEMP EVENT APR <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sanitizer bucket­ <br />bleach & water tor <br />storing wiping cloths <br />SAN JOAQUIN <br />COUNTY— <br />Greotness grows here <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 />I^lce chests ' Refrigerator <br /> Refrigerated truck ^[ce bath and tubs <br /> Other (specify) _________________________________ <br />Title <br />Propane Tank <br />Rinse Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pa9e 8 of 11 TEMP EVENT A! <br />07/01/2024 <br />5-20 Gal. <br />Hand wash Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />pkTub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <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 />Signature <br />Bleacfi and Water | <br />| Health Permit"