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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 (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 />Names of responsible persons to be present in booth during all hours of operation:13. <br />KX W\ NW <br />“Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />Paper Hand Towe1, <br />a <br />Prooane Tank <br />Ice Cooler <br />TEMP EVENT APP <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 items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />Fttra Ico Bags 4 Poca Coctarors nxisl do <br />Vona 0 rncfios off ot the grounO’ <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand w»»h <br />Watlawolw Conlara-r <br />Stwno w/Chafling <br />Dull <br />5-20 Gal <br />Hand wa>h Wo'.w <br />Samtzer buckct- <br />oo.v>. & walx for <br />storing « cloths <br />SAN JOAOUIN <br />------COUNTY- <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />46°F (if food is used the following day, maintain below 41 °F temperature) <br />Q Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify). <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 /> <br /> <br />Title Dau <br />7 <br />Rinse Water <br />QF«o txtinouishar I <br />Scao dispcmor | ’ <br />| Bleach <br />aOi <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 ot 11 TEMP EVEMT <br />07/01/2025 <br />L_L <br />Soap and Water