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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />Signature <br />Health Permit <br />Paper Hand Towfils <br />Sood dispenser <br />Propane Sove <br />Pronana Tank <br />Bleach and Water <br />Piro Extinauishar <br />Ice Cooler <br />Ext/a leo Bags A Food Containers mutt bo <br />stored 6 inchos oft of the ground! <br />Stemo w/Chafting <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gfil. <br />Hand wash Waler <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sanitizer bucket- <br />bloacti & watsr for <br />storing wiping dotha <br />SAN JOAQUIN <br />COL' h. - v <br />Rinse Water <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 />Date <br />SZXtoft "emS W'thin b00lh fOr ,he San'tary C'ean'n9 °f f00d prepara,lon Utens" <br />s^luIioMonetables^onw"9 °n9 °nB 3 b'eaOh <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I <br />Soap and Water <br />^h”9 thG fo,l°Win9 f°r adequate hand washin9 facilitles- but seParate from utensil wash within my <br />H Water supply dispenser with warm water at a minimum of 100°F (i.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 />■ )csr-r>-xl lA^rr> ~ <br />•’’Important** 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 />Completed by: Hx <br />Title <br />Bloach <br />obo <br />Sice chests Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify)- <br />Gudino Board