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proflleZ.cfm (3024x4032)4/16/26, 3:00 PM <br />Environmental Health Department <br />I am providing the following cold temperature control for tho10. <br />Nl A S <br />11. <br />OR <br />12. <br />5-20 gallon container with spigot). <br />13. <br />"•Important** <br />Completed by:14. <br />Signature <br />Health Permit <br />Paper HandTowols <br />BioachPzopeno Stove <br />t <br />LIBleach and Waler <br />Ftta Extinouifher <br />J <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www,slgov.org/ehd <br />CUHiaAo Pano « Af 11 *nn‘Page 8 of 11 <br />1/1https://conventionforce.corn/e/profile7.cfm?downloadpid=2650361&inbrowser=1 <br />EHD IB-02 <br />00/18/19 <br />EilrB Ice Bets i Food Containers must ba <br />sloiod 6 inches o/follbec'^nd' <br />Sterno w/CI>Xlir>g <br />Olli) <br />5 Gal Hand wash <br />WMlewalar ConlaJnor <br />Sanllizer buckm- <br />btaach & water tor <br />storing wipinfl cloUts <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 O»l <br />Handwash Wetor <br />Garbage <br />Can <br />SAN JOAQUIN <br />COU N ■ Y <br />vvvvvv.ojywv.wiyrvt'M <br />TEMP EVENT APP: <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 tho following day, maintain below 4r’F temperature). <br />□ Ice chests Q Refrigerator <br />□ Refrigerated truck O Ice bath and tubs <br />"S^pther (specify)__ <br />_LZ <br />Soap and Wnlw <br />a <br />Rinse Water <br />I Soap dljpenser I <br />Ice Cooler j 1 <br />pI1 <br />I Propane Tank <br />I am providing the following items within mv booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. \\J A, <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 />El 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 />Q Water supply dispenser with warm water at a minimum of 100T (i.e. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <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 />“ftUia ownrr- LL<.f <br />..............OiDate <br />U Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation, <br />ft A-clL _________—— <br />I Cutting Board I