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DocuSign Envelope ID: 7879ADCA-ACCA-4BD1 3-89F166C39E7A <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />Completed by:14. <br />Title Date <br />Health Permit <br />Paper Hand T owds <br /> Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />0 <br />Propane Tank <br />Bleach and Water <br />Fire Fxtinguisncr <br />Ice Cooler <br />[x| 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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 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 />[X] Ice chests Refrigerator <br /> Refrigerated truck S Ice bath and tubs <br /> Other (specify)_______________________________________ <br />I am providing the following items within my booth for the sanitary cleaning pf food preparation utensil <br />Q Three compartment sink. <br />L tlia Ice Bag} & f ood Containers must be <br />stored 6 viches otl ot the ground' <br />Cxlra <br />Water <br />5 Gal Hand wosn <br />Wastewater Container <br />Garbage <br />Can <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 />Stemo w/Chatfing <br />Dish <br />SAN JOAQUIN <br />< ■ 11 ; ■ \ <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0133 | www sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19 <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 events—DocUsion.dby: owner 4/16/2024 <br />Rinse Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Jesse Peralta & Sandre de vos <br />rr LZ <br />Soap and Water <br />5-20 Gal <br />Hand wash Waler