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7/24/23, 1:55 PM <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />LJ Paper towels and pump-style soap container. <br />13. <br />’’Important” <br />Completed by:14. <br />Health Permit <br />Haixf hrw<*:> <br />Propartf Stcne <br />Propane Tank <br />1868 E. Hazelton Avenue I Stockton. California 95205 I T 209 468-3420 1 F 209 464-0138 I www.siaov.orq/ehd <br />https://mail.qooqle.com/mail/u/0/#search/BOSS+MO/QarcJHriCsBXLNTStWXBtSVnaMCwFMIcGwb?Droiector=1&messaaePartld=0.1 <br />U Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />i_ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Title <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Ware> <br />Smxu.’w tHxkek <br />bleach 1 »□!<•< Km <br />witxiu) dcrht <br />ignature <br />SAN JOAQUIN <br />COUNTY <br />All food vendor booths are subject to inspection. Please make a copy of this application <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 eventr—y-2w <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <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 P^Refrigerator <br />□ Refrigerated truck Q Ice bath and tubs <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth; <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />IJ 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 />Li Detergent, bleach, and wiping cloths (cleaning towels). <br />L_l Tub to store wiping cloths in bleach solution. <br />Dtsl> <br />Soap dispensoi <br />Ckjiunj bunta <br />Uloacfi <br />Soup and WuUu Hiom Wula< <br />Evlxi <br />Walm <br />5 Gal Hand w.uh <br />Waalvwawr Conlarw <br />in <br />1/1