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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 (l.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />(8 Paper towels and pump-stvle SQflP container. <br />13. <br />“Important** <br />14. <br />Health Permit <br />Hand Towti* <br />Soap dispenser <br />BleachPropane Stove <br />JI Rinse Water Bleach and Water <br />Fire Extinquteher <br />Ice Cooler <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 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 g Refrigerator <br />□ Refrigerated truck fiD Ice bath and tubs <br />□ Other (specify) __________________________________ <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />fit Three compartment sink. <br />Exira Ice SAtf* 4 Food Conlamert must De <br />itaied fl inchet alt al the gmund1 <br />Extra <br />Watar <br />5-20 Qal <br />Hand wash Waler <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Slamo w/Chaffmo <br />OMh <br />S Gai Hand wash <br />Wastewater Container <br />SamtiMr bucket- <br />bleach & water for <br />ttonng wiping cloths <br />SAN JOAOUIN <br />-COUNTY <br />Owner <br />Title <br />Propane Tank <br />Names of responsible persons to be present In booth during all hours of operation: <br />Mishael Moran <br />6/9/2023 <br />Date <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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths In bleach solution. <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 Qrlalniil to feetlvil coordinator three weeks prior to <br />thle event <br />Completed by: Mishael Moran <br />Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 18-02 Page fl of 11 TEMP EVENT APP <br />07/3/17 <br />tZ7 <br />Soap and Water