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SANJOAOUIN Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />0 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 />3 Paper towels and pump-style soap container. <br />13 <br />’’Important’* <br />Completed by14. <br />Signature <br />Health Permit <br />i P.iimr HuiKl •_ <br />Soup di !>pul i »ui <br />tullin'i tiouid <br />IIIhu. Ii <br />Blwucti ar bl Wulet <br />Q <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Zj Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />SieiPu w/ChattiPQ <br />Dinh <br />■' (..ii itun i wash <br />VJu»lewul«f Corituiui i <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 />S Ice chests ® Refrigerator <br />,.j Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />3 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />S Tub to store wiping cloths in bleach solution. <br />5 20 Gal <br />Hand wasli Watei <br />Gai bage <br />Can <br />www sjgov org.'ehd <br />TEMP EVENTAPP <br />SaniiuHi- Cxk kut- <br />oiujai a wdtvr loi <br />I1, >i ng w<( ) ■ <br /> <br />/ <br />I I xftu \ <br />I Wdlui | <br />Title <br />Kirmu Watei <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 />///^ S., <br />Date <br />.____________________;_______________________ ■■ ■ .' ■■■ <br />t ‘ho /. o ft/'CNX/ ( G/TJ.ouii mu-jf t>v <br />t) Ml< /ICT5 of IfIV IJIUUII'I1 <br />Booth must be on | <br />Concrete Asphalt | <br />Plywood or a TarpL <br /> 7 <br />Soup und W.ilor <br />1868 E Hazelton Avenue | Stockton California 95205 | T 209468-3420| F 209464-0138 I <br />EHD16U2 Page boll I <br />07/01/2024 <br />Names of responsible persons to be present in booth during all hours of operation <br />