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3/4^22, 2:16 PM 20220304_140416.jpg <br />Environmental Health Department <br />w <br />ii. <br />OR <br />12. <br />13 <br />•‘Important** <br />pnd <br />14.Completed by <br />Health Permit J <br />Paper Towth <br />Cut try] BGjrtl <br />Propjfw Stow <br />■—J.- .... <br />Piepane Tanli <br />lUroch Jrxl Wale/ <br />Ice Cooler . <br />L^tru lc» Otigj A Ftwd ContJuHfci tv <br />xtofviJ 6 inc/un oft cl Ihn tjfimnd' <br />9tmo w.C*uffrv] <br />Doh <br />5 Gal Hand w.j*.h <br />Wa'Jrwahrr Conti ner <br />Garbage <br />Can <br />s.in«.-or bvckci <br />Ucach & wnicr for <br />sKJnnq w-r-ryj dcinj <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />6-30 C-J <br />Hand wash Wale* <br />SAN JOAQUIN <br />------COUNTY <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth- <br />[ZfvVater supply dispenser with warm water at a minimum of 100°F (i e 5-20 gallon container with spigot). <br />RUco| <br />Rehx <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4Jj°F (if food is used the following day, maintain below 41 nF temperature) <br />H Ice chests Refrigerator <br />O Refrigerated truck Ice bath and tubs <br /> Other (specify)— <br />0 One separate tub (bucket or basin) for the collection of rinse/waslewater. <br />[ZfPaper towels and pump-style soap container. <br />Lz <br />Soap and <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparatioi <br />preparation <br />this everw <br />of this checklist must be in tho booth at all hours of <br />original to festival coordinator three weeks prior to <br />l/le7 Date/ Z <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink <br />E^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 />E3.Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____________ <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 />06/19/19 <br />I So.x> I -------------1 ‘ <br />| | <br />BBU.0I <br />I RdiMi Water | <br />rtui