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iI- <br />Environmental Health DepartmentSAN JOAOUIN <br />10 <br />11 <br />OR for soapy water, one for rinsing and one for a bleach <br />12 <br />13. <br />"Important** <br />Completed by14 <br />Health Permit <br />Paper Hand Towels <br />Propane blow <br />II <br />Bleach and Waler <br />Ice Cooler <br />Page 8 of 11 <br />Extra Ice Bags S f-ood Containers must be <br />stored 6 tKhes ott of the gmundf <br />Sierno wrt,haHing <br />Drsli <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />I am providing the following for <br />booth <br />5 Gal HarxJ wash <br />Wastewater Conlauiec <br />5-20 Gal <br />Hand wash waler <br />SarxluCT PucSer- <br />bteach & water tor <br />storing wiping Joins <br />Q. Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth dunng all hours of operation <br />----------- ----------------—---------- <br />Title <br />Propane lan> <br />Bleach <br />| Soap dispenser <br />f L <br />Soap and Waler <br />7 <br />Haise Water <br />209 464-0138 | www sjgov^/ehd^ <br />I am providing the following Hems within my booth for the sanitary cleaning of food preparation utensil <br />gf Three compartment sink <br />□ Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water) <br />I Detergent, bleach, and wiping cloths (cleaning towels) <br />□ Tub to store wiping cloths in bleach solution <br />adequate hand washing facilities, but separate from utensil wash within my <br />I am providing the followmg cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 F temperature) <br />Cl Ice chests '^ Refrigerator <br />□ Refrigerated truck ( 7 Ice bath and tubs <br />□ Other (specify)-----------------------------------------------------------------------------------------------------------------------— <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F <br />EHD 16-02 a9® ° <br />07/01/2025 <br />All food vendor booths are sub)ect to inspection Please make a copV, °f h>s; applica^t o <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operatiop Return original to festival coord.nator three weeks pnor to <br />Ouovml/ Hay Cp <br />L > slgnatuTT- Title Date <br />I ue I xltnquisltei <br />I cullmg Hoan.l <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 rinse/wastewater <br />Extra <br />Water