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SAN JOAQUIN 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 />Paper Hand Tov.cls <br />Soap dispenser <br />Cutlmg Hoard <br />BleachPropane Stove <br />Propane I ank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler .5 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />-0'Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Ex/rj lee Hags i Food Containers must be <br />stored 6 inches oil ol the ground' <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 />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <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 />Stemo w/Chattmg <br />Dish <br />5-20 Gal <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />willinm von oertz _______________ <br />.,l <br />0 <br />8/15/23 <br />Date <br />Nathan Marcus <br />Signature <br />CEO <br />Title <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 8 of 11 TEMP EVENT APP <br />06/19/19 <br />5 <br />Rinse Water <br />rT C __1 <br />Soap and Water <br />Health Permit