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Environmental Health Department <br />11. <br />OR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />14.Completed by:Anrlrpa P <br />Signature Title <br />flHealth Permit <br />Paper Hand 7 owbIs <br />Soap dispenser <br />Culling Board <br />Propane Sieve Bleach <br />Rinse Waler <br />Fire Extinguisherfl <br />Ice Cooler <br /> 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 />5 Gal Hard! wash <br />Waste-waler Contninor <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach a water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Anrirea Piiiidn Alejandro Ochoa ___________________ <br />u <br />Exira Ico Hags & Food Containers must bo <br />stored 0 Inches oil of the gtound! <br />Soap and Waler <br />' I <br />r*/. <br />10. <br />Propane T ank <br />03/22/26 <br />Date <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5-20 Gal <br />Hand wash Water <br />A SAN JOAQUIN <br />------COUNTY— <br />Gr<?alness r/rows here. <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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />O Other (specify)_______________________ <br /> 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 /> 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 mv <br />booth: 7 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www sjcehd com <br />O^1®'02 Page 8 of 11 TEMP'EVENT APP <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.