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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Title DateSignature <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler J <br />TEMP EVENT APP <br />■_______________________________________ <br />Health Permit <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 />Paper towels and pump-style soap container. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />lution (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 />Extra Ice Bags & Food Containers must bo <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />6-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Water <br />SAN JOAQUIN <br />------COUNTY------- <br />(jrcntrcn grows herp <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 />]X^I Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Propane Tank <br />I Bleach <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 />“Important*' <br />Names of responsible persons t< Adxiana—''sons to be present in booth during all hours of operation:Valdovi-no-S—----------- <br />- I <br />Soap and Water <br />IF II r <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 TEMf* CVCf.’T Al <br />06/29/2023 <br />I Soap dispenser | ------------ <br />Do