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Environmental Health Department <br />11. <br />OR <br />12.WHS <br />®-Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />’‘Important** <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />[Cutlino Board <br />BleachPropane Slova <br />Bleach and Water <br />Fira Extinouishara <br />Ice Cooler <br />E-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 />Exira <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucfcet- <br />bleach & water for <br />storing wiping doihs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal <br />Hand wash Water <br />SANJOAOUIN <br />-COUNTY------ <br />Tide <br />EMra fee Bags d Food Qpnteiws musf he I <br />I sfored 6 Mtnofol lt» gnundt <br />Date <br />|u?o^ (onl tXSpfOr S°aPy Wat0r' °ne f°r rinS'n9 3nd °ne fOr 3 “eaCh <br />® Detergent, bleach, and wiping cloths (cleaning towels). <br />£3 Tub to store wiping cloths in bleach solution. <br />| Propane Tank <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 APR <br />07/01/2024 <br />k **emS booth for the sanitary cleaning of food preparation utensil <br />vrcii tcr.% y.-o^vj. here. <br />1 the fo5<^n9 00,(1 temperature control for the cold holding of potentially hazardous foods below <br />45 F (it food is used the following day, maintain below 41 °F temperature): <br />®,cecheste Refrigerator <br /> Refrigerated truck ice bafo arKj tubg <br />® Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />Dooin. <br />sbiMULJ7~/ <br />Soap and Water Rlnsa Water <br />13. <br />.. <br />14. <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, r --------- <br />Completed by: j <br />Signature