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Environmental Health Department <br />9. <br /> Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />10. <br />Other <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <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 /><3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />-Q Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cuttinq Board <br />BleachPropane Stove <br />WWW. <br />I I <br />1868 E. Hazelto <br />EHD 16-02 <br />07/01/2025 <br />Three compartment sink. <br />Three deep tubs (basins 6-8Jpches minimum), one for soapy water, one for rinsing and one fora bleach <br />solution (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gal <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chaffing <br />Dish <br />Sanitizer txjcket- <br />beach & water for <br />storing wiping cloths <br />o|Z <br />raye o ui 1z <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following cold temperature control forthe 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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />(specify), <br />SAN JOAQUIN <br />-COUNTY <br />f Greatness grows here. <br />I am providing the following hot temperature control forthe hot holding of all potentially hazardous foods above <br />135°F: <br />\$FCamp stove <br />1—\____ _____Jjo—I—W <br />Temp event app <br />lue | Sfcr 11, k-*al <br />meats, tamales, cooked beans, rice, <br />Names of responsible persons to be present in booth during all hours of operation: <br /> U005V 10^~]______ <br /> <br />‘"Important** 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 an^-operation. Return original to festival coordinator three weeks prior to <br />thisevent^C/^ —, <br /> <br />Date