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SAN JOAOUIN Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />(vf Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by:14. <br />Health Permit <br />Paper Hand Towels <br /> Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane I ank <br />Bleach and Water <br />Tiro Extinguisher <br />Ice Cooler <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 />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 />ExTra Ice Bags & I ood Container must be <br />Stored 6 inches oft of the ground' <br />Slemo w/Chaffmg <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <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 larp. <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 />0 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___ ________________________ _____ <br />5-20 Gal <br />Hand wash Water <br />Owner <br />TitleSignature <br />at <br />Rinso Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Claudia Hazelwood (7576336345). Jessica Jimenez (9652653187) <br />1868 E Hazelton Avenue | Stockton, California 95205 | 1 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />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 />Mn).;?’ /; < 2/27/2024 <br />Date <br />1 <br />Soap and Water