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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 lOO’F (l.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewaler. <br /> Paper towels and pump-style soap container. <br />13. <br />‘"Important** <br />14. <br />Pnpor Hand fowols <br />Culllnf) Donrd <br />BlvacbPropnno Slow <br />r.. <br />ProponoTnok <br />Blench mid Wnlor <br />Ice Cooler <br />Names of responsible persons to be present In booth during all hours of operation: <br />Andrew and Casey Osborno ______ _ <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />6 Gnl Bond waili <br />Wnilownlor Conlnlnor <br />Garbngo <br />Can <br />Snnilizm buckol- <br />blnnch & wnlnr lor <br />iloiing wIpli'O clolhn <br />Cxlrn <br />Wnlor <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Slorno w/Chalfing <br />Dl»h <br />SAN JOAQUIN <br />COUNTY <br />08/10/2021 <br />Date <br />Operator/ Secretary <br />Title <br />-■-J14,1 iys.; <br />Health Permit <br />_z <br />Sonp end Wnlor <br />z <br />ninsoV/alor <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.s)gov.org/ehd <br />EHD 16-02 Pago Oof 11 TEMP EVENT APP <br />06/10/10 <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 bo In tho booth at all hours of <br />preparation and operation. Return original to festival coordinator throe weeks prior_tp <br />this event. <br />Completed by: /I'(QiAiM./M., <br />Signature <br />6-20 Gnl. <br />Y* Hand wash Wnlor <br />Soap dlsnonaor ---------- \ <br />Gxlrn Ico flop* A food Contol/iorc musl bo <br />tloiod 6 Indios off ol llio aioii'id! <br />I am providing tho following cold temperature control for tho cold holding of potentially hazardous foods below <br />45°F (if food is used tho following day, maintain below 41 °F tomperature): <br /> Ice chosts Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />Gel Other (specify) N/A _______________________ <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 /> Dotergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths In bleach solution.