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,■ s'Environmental Health Department <br />11. <br />OR <br />12. <br />[ZO Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />P One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[7] Paper towels and pump-style soap container. <br />13. <br />77 <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire ExtinguisherQ <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra lea Bags 4 Food Containers must bo <br />stored 6 Inchos off of Iho ground! <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer buckol- <br />hleach & waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterne w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Waler <br />SAN JOAQUIN <br />COUNTY- <br />f n'cnl hcs s t/rot'.'s ht’fc. <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 />|xj Ice chests Refrigerator <br />n Refrigerated truck Ice bath and tubs <br /> Other (specify)______________________________________________________________ <br />Rinse Water <br />Propane Tank ----------------» <br />aHI / <br />Soap and Water <br />**lmportant** <br />" i <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[x] 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />XI '.7 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/01/2024 <br />Names of responsible persons to be present in booth during all hours of operation: <br />Bf i‘» t <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. Zxz- / <br /> <br />Signature-—1^ Title