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Environmental! Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />Title <br />i <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Rinsa Water Bleach and Waler <br />Fire Extinguisherfl <br />Ice Cooler <br />Pago 8 of 11 <br />Extra /co Bags & Food Container must be <br />stored 6 Inches ott of the gmundl <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />blcach 8 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />____ <br />1/24/2025 <br />—uaiu <br />Propane T ank <br />A°’.- <br />! <br />I am | <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />□ Refrigerator <br />(p4ce bath and tubs <br />k/fWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />fi/fone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Health Permit <br />5-20 Gal. <br />5^ Hand wash Water <br />jLMM, <br />Names of responsible persons to be present in booth during all hours of operation: <br />Yoeun Yan <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 />Completed by: [Yoeun Yan, Sole Business owner <br />Signature <br />**important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />0^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 />0 Tub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pago 8 of 11 TEMP EVENT APP <br />07/3/17 <br />I QT L.. _lL <br />I / <br />; Soap and Waler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Vy SAN JOAQUIN <br />J' ------COUNTY------ <br />G mo loess t/rotvs here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />tZf Ice chests <br />□ Refrigerated truck <br />□ Other (specify)