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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13 <br />"Important'* <br />Completed by:14. <br />Pape’ Hand 7 cwveli <br />Cutling Board <br />BleaciiPropane Stow <br />a <br />Rinse Waie*Bleach and Waler <br />Ftre Extinguisher <br />Ice Cooler <br />Sterno w'Chaftng <br />Dtsh <br />Extra <br />Water <br />5 Gai Hand wash <br />Wastewate’ Contaner <br />Garbage <br />Can <br />Sanrtuer bucket- <br />bleach & wale’ for <br />storing wiping cloths <br />Booth must be on <br />Concrete Asphalt, <br />Plywood or a Tarp <br />1^ Water supply dispenser with warm water at a minimum of 100°F (i.e 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Ij^Paper towels and pump-style soap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Names of responsible persons to be present in booth during all hours of operation <br />____________Jesus Solis and Carmen Solis_______ <br />5-20 Gal <br />Hand wash Wale- <br />Greafnr-ss ^rows here <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 />B^lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />SAN JOAQUIN <br />COUNTY <br />Owner <br />Title <br />J <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 6 of 11 TEMP EVENT APP <br />06119/19 <br />[ Health Permit <br />09/07/21 <br />Date <br />liam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />ft^Three compartment sink. <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 />jj*] Detergent, bleach, and wiping cloths (cleaning towels). <br />[XTub to store wiping cloths in bleach solution. <br />J Ptopanc Tanl^ <br />J Soap dispense' <br />Extra Ice Bags & Food Containers must be I <br />stored 6 inches ofl of the ground1 | <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. t -1 <br />o I(c <br />Signature