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Environmental Health Department <br /> <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 />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cultinq Board <br />BleachPropane Stove <br />I <br />Bleach and Water <br />Fire Extinauisher <br />TEMP EVENT APP <br />I <br />Soap and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />5 Gal Hand wash <br />Wastewater Container <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____ <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 />c) 14 e K <br />Title <br />L___ <br />Rinse Water <br />Extra Ice Bags & Food Containers must be I <br />stored 6 inches off ot the ground1 ■ <br />1^ <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. A . r,. <br />_______U __________r_____________<37z cyz <br />’ Signature Title Date <br />5-20 Gal. <br />v- Hand wash Water <br />Prooane Tank '4--------------------------- <br />■ <br />Z - <br />Ice Cooler <br />SANJOAOUIN <br />------COUNTY------- <br />Greotncss grows here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 8 of 11 TEMP EVENT A! <br />07/01/2025 <br />I am | <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />□ Ice chests ELRefrigerator <br />□ Refrigerated truck 0 Ice bath and tubs <br />□ Other (specify)._