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Environmental Health Department'<• <br />10. <br />11. <br />OR <br />12. <br />ETWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />f^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Pf’aper towels and pump-style soap container. <br />13. <br />14. <br />DateTitle <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cuttinp Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinquisher <br />TEMP EVENT APR <br />J. <br />Soap and Water Rinse Water <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 />Stemo w/Chaffmg <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />H^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 />ElDetergent, bleach, and wiping cloths (cleaning towels). <br />[pYub to store wiping cloths in bleach solution. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground I <br />Extra <br />Water <br />Signature <br />Ice Cooler ; <br />I / <br />-----------J <br />/ <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 />Q'lce chests ^Refrigerator <br />Qd^efrigerated truck Ice bath and tubs <br /> Other (specify) <br />Names of responsible persons to be present in booth during all hours of operation <br />‘‘Important**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 operatiory? Return original to festival coordinator three weeks prior to <br />this event. <br />Completed by: <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />1 — — - T-r—a «r* a iEHD 16-02 Page 8 of 11 <br />07/01/2025