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Environmental Health Department <br />11 <br />OR <br />12 <br />KJ 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 />13 <br />•‘Important** <br />14.Completed by: <br />Health Permit <br />Stemo w/Chafirfl <br />Paper Hand T oweii <br />Cuttinq Board <br />Propane Slave <br />Rmae Water Bieacn and WaterSoap and Water <br />Fire EJdinguisner <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 />Names of responsible persons to be present in booth during all hours of operation <br />Darya Artsyman <br />5 Gat Hand wash <br />Wastewater Conume' <br />Garbage <br />Can <br />Booth must be on <br />Concrete Asphalt <br />Plywood, or a Tarp <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 />5-20 Gal <br />Hand wash Water <br />Sanitizer bucfcet <br />bleach & water tor <br />slorKtg wip<ng cloths <br />SANJOAOUIN <br />-----COUNTY------- <br />Greatness grows 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 41T temperature) <br />[X] Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Representative <br />Title <br />Extra Ice Bags & Food Contone'S must be ■ <br />stored 6 inches of or the ground’ <br />All food vendor booths are subject to inspection Please make a copy of this application in <br />< copy of this checklist must be in the booth at ell hours of <br />leturn original to festival coordinator three weeks prior to <br />6-12-26 <br />Date <br />preparation for this event. <br />preparation and operation. <br />this eveniyzU^I/ <br />/ / Signature <br />' T~‘‘ "z < <br />hilFOP’ir ' <br />10. <br />^robane T arv <br />s i'1 <br /><------------4Ice Cooler <br />_________z <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 APP <br />07/01/2025 <br />Disn <br />Soap d'spenser <br />Extra <br />Walo*