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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />S^Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />nature <br />j Health Perm it | <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove Bleach <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />! <br />ffl'Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H*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 />preparation fc <br />preparation ai <br />this event. , <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <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 />SANJOAOUIN <br />COUNTY- <br />Owner <br />Title <br />11/5/2024 <br />Date <br />I <br />Soap and Water <br />“Important** <br />I am providing the following cold temperature control for the 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 S'lce bath and tubs <br /> Other (specify) <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />All food^vendor booths are subject to inspection. Please make a copy of this application in <br />* x_. thjs event A copy of thjs check[jst must be in the booth gt a|( bourg of <br />operatiorL Return original to festival coordinator three weeks prior to <br />Names Jo"aganPdeKlm PasV^nte (P^rtneg)9a"hourao'opera“°n: <br />Ice Cooler <br />____ y <br />S?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 />H^Detergent, bleach, and wiping cloths (cleaning towels). <br />GTrub to store wiping cloths in bleach solution. <br />zzjl_ - <br />■ ■I | <br />booth PrOV'd'n9 the follOW'ng for adecluate hand washing facilities, but separate from utensil wash within my <br />lun « no Hazelton Avenue 1 stockton’ California 95205 | T 209 468-3420 | F 209 464-0138 I www sjqov orq/ehd <br />06/29/2023 Pa3e8°f11 TEMP EVENT APP <br />Garbage <br />Can <br />Cutting Board