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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Paper HanO Towtik <br />Ssap dispenser <br />Cuss^aQ3.-d <br />BeachP.'upae? Sfcve <br />w <br />Propaw rank <br />Stesch end Water <br />Ice Cooler i <br />□ TViree 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 />□ Detergent, bleach, and wiping ctoihs (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />SwnwWChsSro <br />Dish <br />5-20 Gsi. <br />hw«j wwh w«sr <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />0 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 />cf Paper towels and pump-style soap container. <br />Extra Ise Sags 6 Fond Cu'i&wjutc mist de <br />sfoesd 6 itel»s on offfK gfauod! <br />SGoiHandwssh <br />WastsvAtef Cuiaia <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />SaniSzer bucket- <br />ticztf: A nstEC far <br />siccing wiping dWhs <br />SAN JOAQUIN <br />-----COUN'V— <br />Health Permit <br />Title <br />“Important** <br />JD.U:flL <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pegs 8 of 11 TEMP EVENT APP <br />06/23/2023 <br />IT <br />Rft»ieW5»r <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 />U Signature <br />3/3//2M <br />Date <br />Ji <br />z^, I RreErfiKfliftliW <br />Names of responsible persons to be present in booth during all hours of operation: <br />Adi/yn and Lotion AorxgX__________________________ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />i am providing foe following arid temperature control for the cold holding of potentially hazardous foods below <br />45T (if food Is used the following day, maintain below 41 °F temperature): <br />□ Ice chests Cf Refrigerator <br />□ Refrigerated truck Q Ice bath and tubs <br />□ other (specify)_______ _____________________________________ <br />, / <br />S»?«ndWai=r