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Environmental Health Department <br />11. <br />12r <br />M Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />lyCI One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />^Important' <br />i <br />Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />i. <br />Bleach and Water <br />Firo Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <br />14. <br />I <br />10. <br />I <br />I LJ <br />Propane Stove <br />OR <br />i ® 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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra /co Bags 4 Food Containers must ba <br />stored 6 Inches oT of the ground! <br />Stemo w/Chalfing <br />Dish <br />5 Gal Hand wash <br />Wastewaler Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Extra <br />Water <br />Title <br />Propane Tank ** <br />■ L>& <br />SANJOAOUIN <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 />® Ice chests Refrigerator <br /> Refrigerated truck EJ Ice bath and tubs <br /> Other (specify) <br />IF U <br />Rlnsa Water <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. RetgiTi original to festival coordinator three weeks prior to <br /> <br />Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago 8 of 11 T”/” C'.'Zf.T A! <br />07/01/2025 <br />Sanitizer bucket- <br />bleach & water for <br />I storing wiping cloths <br />71 <br />! <br />13. ■ Names of responsible persons to be present in booth during all hours of operation: