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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />utensil wash within my <br />Ion container with spigot). <br />Q Paper towels and pump-style soap container. <br />13. <br />14.Completed by:ngcorv <br />Health Permit " <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Rinse Water <br />Fire Extinguisher <br />■ <br />Page 8 of 11 <br />S Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gall <br />E3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />1868 E. <br />EHD 16-02 <br />06/29/2023 <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />C O (J N T Y <br />3- <br />I <br />7 ~ ® <br />Ice Cooler I___I_F <br />11/7/2024 <br />Date <br />Owner <br />Title <br />Propane Tank <br />■-------------------------------------3| <br />S W'thin my bOOth f°r the sanitary cleanin9 of food preparation utensil <br />Garbage <br />I Can <br />“Important** <br />pltriciaf Hansen ble PerS°nS t0 be Present in booth during all hours of operation: <br />Patricia Hansen SSSiX, <br />-----------------—SHU Ml'M 1 er 11 MJ 1 <br />Signature <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). 9 <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Soap and Water <br />' the '7te™Perature contro1 for the cold holding of potentially hazardousjfoods below <br />45 F (if food is used the following day, maintain below 41 °F temperature): <br />O 'ce chests Q Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br />S Other (specify) free:eer and refrigerated soft serve machine <br />Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 of 11 TEMp EyENT App <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. ' - --------------------------- <br />atrlda Hansen <br />c=>us <br />»J1 88W ------- <br />boothPr°ViClin9 the follOWing for adecluate hand washing facilities, but separate from <br />— ' —JI'—- <br />■ _ 'I' *