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Environmental Health Department <br />9. <br /> Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />meats, tamales, cooked beans, rice, <br />10. <br />Other <br />11. <br />OR <br />12. <br />ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />aper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />I I <br />1868 E. Hazelto <br />EHD 16-02 <br />07/01/2025 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno w/Chatting <br />Dish <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />IU6 | Sttr srrnmj-p HnJT— po—|—WWW. <br />Temp event app k <br />'^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <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 />k 45°F (if food is used the following day, maintain below 41°F temperature): <br />pKJce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />(specify) <br />SAN JOAQUIN <br />------COUNTY------- <br />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 />B^Camp stove <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />p/lTiree compartment sink. <br />Three deep tubs (basins 6-8 inches minimum), one forsoapy water, one for rinsing and one fora bleach <br />solution (one tablespoon of bleach per gallon of water). <br />■^Detergent, bleach, and wiping cloths (cleaning towels). <br />^jK^Tub to store wiping cloths in bleach solution. <br />**lmportant**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 events < a i <br /> <br />Signature Title Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />ip v\cq m t o <br />ifO <br />rage o oi 1 z"