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■ Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important” <br />14. <br />signature <br />Health Permit <br />Paper Hand Towels <br />Propane Stovo <br />Propane Tank <br />Blench and Water <br />TEMP EVENT APP <br />Extra Ice Bags & Food Containers must be <br />stored 6 Inches on of the ground! <br />5 Gal Hand wash <br />Wastewoter Coniainer <br />5-20 G2I. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chatting <br />Dish <br />Sanitizer bucket- <br />bloach & water for <br />storing wiping cloths <br />Extra \ <br />Water <br />I t. <br />SAN JOAQUiN <br />COUb. - <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 tp <br />this evenfc-^ ,7 3, ^6 <br />Title Date <br />1868 E. Hazelton Avenue j Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org^hd <br />EHD 16-02 Page 8 of 11 TEMP EVENT Al <br />07/01/2024 <br />Completed by: <br />_Z <br />Rinse Water <br />1^, Fire Extinguisher <br />_z <br />Soap and Water <br />, Ice Cooler <br />I <br />lam providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />'fp One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of respiysible pegons^o be^resent in bootfijiuring all hours of operation: <br />Ice chests Q Refrigerator <br />□ Refrigerated truck Ice bath and tubs <br />□ Other (specify)' <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 />Soao disoenser ---------- <br />Bleach I <br />sb I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: