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Environmental Health Department <br />10. <br />11 <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />LPtupai uj Sltmi <br />Ruise Water Bleach and Water <br />Fire Exfinuuishw <br />Page 8 of 11 TEMP EVENT APP <br />I <br />Ice Cooldr <br />Sier no w'C hall lug <br />Dish <br />Water <br />Garbage <br />Can <br />SariH iznr btK. koi <br />I.•■loach K Witter tei <br />r.turing wiping ciolhii <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastewater Ccmtainor <br />fi-20 Gal. <br />Miiiid w«»Eih Watei <br />I am providing the following cold temperature control for the cold holding ot potentially hazardous foods below <br />45°F (if food is used the followingday, maintain below 41 °F temperature): <br /> Ice chests /^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />I I Other (specify)_________________ <br />11 /5/24 <br />Date <br />SAN JOAQUIN <br />COt i N T Y <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[_J One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />r? r <br />Soap and Water <br />I,., 0 I'?Af' | <br />\am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Jn[Three compartment sink. <br />‘‘Important** <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 />IJ Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation- <br />---------Tam Tran__ ___________________ <br />| I «r>k <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: <br />______________g________• < , ■ > i <br />Lxtfit tc(r Lings & Food CtMtainors must ba <br />alarfl of/ of Wjo givuiuF _ <br />Haze,ton Avenue | Stockton, California 95205 | T 209 468-3420 J F 209 464-0138 | www.sjqov.org/ehd <br />O6P9/10 I Page 8 of 11 TC”? A: <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. r .Y’-zJ Owner <br />Signature Title <br />Soap dispense <br />Cutliihq Bcuifit