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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />’‘Important** <br />14.Completed by: <br />Health Permit <br />Caper Hand Towel* <br />BleacCPropane Stove <br />Blench and Waler <br />Fro CKtinpuiahar <br />Ice Cooler i i <br />Stemo w/Chaffing <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />WaBtowatrw Conunnnr <br />5-20 Gat <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach A water tor <br />stonno wiping doth* <br />SAN JOAQUIN <br />COUNTY- <br />Soap dispenser <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 />^^Hce chests Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify)^ <br />& tra les Bags & hood Containers must be H <br />stored 6 Inches off of the ground' W <br />z <br />Soap and Water Rinse Water <br />| Propane Tank <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 \ . x- , , <br /> <br />Signature Title Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />jXEtetergent, bleach, and wiping cloths (cleaning towels). <br />^Tub to store wiping cloths in bleach solution. <br />£glA/ater supply dispenser with warm water at a minimum of 100uF (i.e. 5-20 gallon container with spigot) <br />^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />I^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <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 />| Culling Board I