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Environmental Health Department <br />11. <br />OR <br />12. <br />| | Paper towols and pump-stylo soap container. <br />13. <br />^Important** <br />14. <br />Signature <br />IF'upo* I land Towols <br />[ S<»>|» disponnnr | <br />Blonch1’iop.iixi Slovo <br />loo Cooler , !> Gal I (and wash <br />Wnstowalor Coni, liner <br />Giirbarjc <br />Can <br />Siuiibzoi bucko! <br />bloacli R wiilor fcx <br />sli>riii<) wiping doth:. <br /> Booth must lx; on <br />Concrcto, Asphalt, <br />Plywood, or a l arp. <br />1868 I:. I la/ellon Avonuc | Stockton, California 9520!) | T 209 468-3420 | I- 209 464-0138 | www.sjgov.org/ohd <br />IJID16 02 I’atjn II of 11 TEMP EVI-NT’API’ <br />1/2023 <br />I <br />| I'lop.inn lank <br />I am providing the following for adoguato hand washing facilities, hut separate from utensil wash within my <br />booth: <br />k^Watcr supply dispenser with warm water at a minimum of 100T (i.o. 5-20 gallon container with spigot). <br />| ’] Ono soparato tub (bucket or basin) for the collection of rinse/wastowalor. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^\] Three compartment sink. <br />[. | Three doop tubs (basins 6-8 inches minimum), one for soapy water, ono for rinsing and one for a bleach <br />solution (ono tablespoon of bleach per gallon of water). <br />( ] Detergent, bleach, and wiping cloths (cleaning towels). <br />| J Tub to store wiping cloths in bleach solution. <br />SANJOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />I am providing the following cold tomporaturo control for the cold holding of potentially hazardous foods below <br />4{>"F (if food is used the following day, maintain below 41 °F temperature): <br />Jxflce chests ^Refrigerator <br />[ ] Refrigerated truck L Ice bath and tubs <br />O Other (specify)- <br />| cultinn Honnl <br />| | Blnni:li imrl W.ilcr <br />( Extra \ <br />Wator <br />/ tlm /co linos XI ood CcfHohors mist bo yJ <br />sliuml 6 Mios off ol tho grounit! M I <br />•P hC- O.' <br />10. <br />| So.ip .-u»l W.C- i || U:ri:.e Walor <br />I iro I xtiiin<ii:;lior <br />Slomo w/ChaflMifl | <br />| Health Permit <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 bo in the booth at all hours of <br />proparatioii aiid operation. Return original to festival coordinator three weeks prior to <br />this <br />Completed by: ____ <br />Title