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REC-008 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q-Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />O’ Paper towels and pump-style soap container. <br />13. <br />Important** <br />04-15-2026 <br />14.Completed by: <br />Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cullinq Board <br />BleachPropane Stove <br />Irr —" Ii i <br />Propane Tank <br />Bleach and Water <br />Pre Entmpuisherfl <br />Names of responsible persons to be present in booth during all hours of operation: <br />Andrea de la Cruz <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Exira Ice Bags i Food Comakers must be <br />stored 6 inches oft of the ground! <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 />Sier no wChalfing <br />Dish <br />Extra <br />Waler <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler lor <br />slonng wiping dolhs <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness 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 />O' Ice chests Q- Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />•dgnod vM GovOS com <br />£)e <br />K«r 7oc6c7B»-5016-<8.V^36l^nn<l?M»le*0oiyi ■ciiui c <br />1 <br />Soap and Water <br />r <br />Rinse Water <br />Q 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 ol 11 TEMP EVENT APP <br />06/19/19