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Docusign Envelope ID: FCB4E7EA-D3D1-48BO-BC03-D006B1266283 <br />Environmental Health Department <br />10. <br />ice chest <br />11. <br />OR <br />12. <br />S Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />14. <br />Title DateSignature <br />Health Permit <br />Paper Hand Towels <br />Culling Board <br />BleachPropane Stove <br />L <br />Bl Bleach and Water <br />Fire Extnguisher <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 />0 Three compartment sink. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br />S Ice chests 0 Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) ICe chest <br />Extra Ice Bags i Food Containors must be <br />stored 6 inches off ot the ground! <br />5 Gal Hand wash <br />Wastewaler Container <br />Sanitizer bucket­ <br />bleach & water tor <br />stonng wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />V/ater <br />5-20 Gal. <br />Hand wash Waler <br />Stcmo w/Chaffing <br />Dish <br />Ice Cooler <br />________ __K <br />SAN JOAQUIN <br />COUNTY <br />J <br />.! <br />Propane Tank <br />05 ■ 7 <br />Soap and Water <br />/ <br />Rinse Water <br />| Soap dispenser <br />I <br />-■..j <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 operation. Return original to festival coordinator three weeks prior to <br />Owner 4/15/2025Completed by:H^ ___________________ <br />Names of responsible persons to be present in booth during all hours of operation: <br />Tomeako Honesto <br />0 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Garbage <br />Can