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REC-008 <br />Environmental Health Department <br />ere. <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />SUBMIT14.Completed by: <br />Health Permit <br />Paper Han* Towels <br />Soap dispenser <br />BleachPropane Stove <br />0 <br />Propane Tank <br />Bleach an* WaterRinse Water <br />FireE*tm*uisher <br />Ice Cooler j <br />__[Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />—htion (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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno wiChalhnj <br />Dish <br />/ Refrigerator <br />Ice bath and tubs <br />5 Gal Han* wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach iwaterlor <br />stormj wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Alejandro Kandalaft, Maria Castillo, Armando Carbajal <br />5-20 Gal <br />Hand washWater <br />1[/Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />| y ^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />| y ^aper towels and pump-style soap container. <br />SAN JOAQUIN <br />------C«UNTY------ <br />/fop^ Greatness grows h <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 /> Ice chests <br />Refrigerated truck <br />Other (specify) <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.Y <br />Signature <br />_z <br />Soap an* Water <br />11-4-2Q24 <br />Date <br />J-am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Z 'hree compartment sink. <br />Owner <br />Title <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 APR <br />06/19/19 <br />Extra ice Haos & food Containers must ba l| <br />stored 6 inches art at the ground.' | <br />Cutting Board