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Environmental Health Department <br />11. <br />OR <br />12. <br />Q Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />14.Completed by: <br />Signature <br />Paper Hand Towals <br />Propane Steve Bleach <br />Bleach and Water <br />Fit* Extinguisherfl <br />Ice Cooler <br />0 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 rinseZwastewater. <br />Extra Ice Bags 4 Food Containers must be <br />stored 6 Inches off of the ground! <br />Exira <br />Water <br />Garbage <br />Can <br />Slemo w/ChaHng <br />Dish <br />6 Gal Hand wash <br />Wastewater Container <br />6-20 Gal. <br />Hand rrash Watsr <br /> Booth must be on <br /> Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Santtlzar buckot- <br />bteach & water for <br />storing wiping cloths <br />Boun Ouk & Emily Ouk <br />“Important** <br />Propane Tank 7 <br />Rmse Water <br />Health Permit <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />a SAN JOAQUIN <br />'> ------COUNTY------ <br />Greafness grotvs Acre. <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 />S Ice chests Refrigerator <br /> Refrigerated truck 0 Ice bath and tubs <br /> Other (specify)__________ <br />Soap dispenser | <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 />0 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: 7 <br />Soap end Water <br />t-i'. <br />■■'I <br />c-<G.-oi<e <br />10. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-34201 F 209 464-0138 | wwwsicehdcom <br />JX1?"02 P«B«8OM1 temp event app <br />| Cutting Board <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 event. <br />Sole Business Owner 4/4/2025 <br />Title Date