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Environmental Health Department <br />10. <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Propane Sieve Bleach <br />0uPropane Tank <br />Rinse Water Bleach and Water <br />Fire Extinquisher <br />Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | <br />Page 8 of 11 <br />5 Gal Hand wash <br />Wastewater Container <br />F 209 464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />1868 E. <br />EHD 16-02 <br />07/01/2025 <br />Slcrno w/Chaffing <br />Dish <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />------COUNTY <br />Signature <br />rz <br />Soap and Water <br />11' n items Within my b00lh f0r the sanitary cleaning of food preparation utensil <br />OR <br />____ <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />□ Three compartment sink. <br />(gj 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 />yjub to store wiping cloths in bleach solution. <br />providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />Water supply dispenser with warm water at a minimum of 100“F (l.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />---------------------------Pt I <4 <ct <; <br /> <br />' the followin9 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 />04ce chests Q Refrigerator <br />□ Refrigerated truck ice bath and tubs <br />□ Other (specify) _______ _______ <br />Ice Cooler <br />Cuttinq Board ------- <br />nln ?°r hS are subject lo ,nspection. 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 />tn is ovent. <br />________LrJ/^r 81-2,12 S <br />Title “ 7 Date