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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 />■ <br />“Important** <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />BleachPropane Stove <br />— <br />Prop ar.e Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />D U i <br />EHD 16-02 <br />07/01/2024 <br />Star no w/Chaffing <br />Dish <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />I am Dividing the following for adequate hand washing facilities, but separate from utensil wash within my <br />boottr <br />_z <br />Soap and Water <br />Signature Title Date <br />; SANJOAOUIN <br />-----COUNTY------ <br />Greotness giowj 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 Ice bath and tubs <br /> Other (specify)____________________ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> 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 />□f Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />IT <br />Rinse Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16 02 Page B of 11 TEMP EVENT APP <br />| Soap dispenser | <br />Extra Ico Bags S Food Contalnors mustbJ <br />stored 6 inches off of the ground! | <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <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 />thi^ev^ntAv^. - “7 4s)