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Environmental Health Department <br /> <br />10. <br />11. <br />OR <br />12.utensil wash within my <br />13. <br />“Important** <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />I <br />Propane Tank <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Extra <br />Waler <br />SAN JOAQUIN <br />—COUNTV <br />1 <br />Rinse Water <br />T <br />Soap and Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />U Three compartment sink. <br />0 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 />Bleach and Water | <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 eventQ ~ ------------------------ <br />Title Date <br />| Soap dispenser 1 <br />Bleach L. <br />zWO <br />ehd Hazelton Avenue I Stockton. California 95205 | T 209 468-3420, F 209 464-0138 | <br />07/01/2025 Page 8 of 11 <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />boothPrOVid'n9 the followin9 for adecluate hand washing facilities, but separate from <br />[Tfwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />E2) One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />d Paper towels and pump-style soap container. <br />‘ the foJfT'ng cold temperature control for the cold holding of potentially hazardous foods below <br />4,b I- (it food is used the following day, maintain below 41 °F temperature): <br />Q'lce chests Q Refrigerator <br />EH Refrigerated truck EH Ice bath and tubs <br /> Other (specify)