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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />/N;13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap disponaor <br />Culling Board 3Propane Stove Bleach <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />i Ice Cooler , <br />/ <br />Rinse Water <br />El ID 16-02 <br />07'01/2024 <br />t:xtra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer buckot- <br />Weech Si waler (or <br />storing wiping ololhs <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Slorno w/Chafflng <br />Dish <br />Title <br />SAN JOAQUIN <br />COUNTv <br />__L <br />Soap and Water <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />P^??^!.IOn for,this event A copy of this checklist must be in the booth at all hours of <br />p. wfyv,, u.ivi I UIIU .WIXjiailUI <br /> * Signature <br />0 Ice chests Q Refrigerator <br />□ Refrigerated truck bath and tubs <br />□ Other (specify) <br />/^hZX9partZOtWs,h9k.it6mS mV b0°th f°r ‘he 8ani'ary Cleanin9 °f f00d prepara«on utensil <br />gjon for S°apy Water' °"e for rinsi"S and “no bleach <br />H Detergent, bleach, and wiping cloths (cleaning towels). <br />U Tub to store wiping cloths in bleach solution. <br />**lmportant** <br />boao7h:Pr°Vid,n9 the f°ll0Win9 f°r adeqUate hand Washing faCilitieSl but separate from utensil wash within my <br />Kf Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^jRaper towels and pump-style soap container. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 of 11 TEMP EVENT APP <br />lamesjjf responsible persons to be present ip booth during all hours of operation- <br />_____________ <br />a copy of this application in <br />P[®ParatioJ1 anc^operation. Return original to festival coordinator three weeks prior to <br />Date