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SAN JOAQUIN Environmental Health Department <br />10. <br />11 <br />OR <br />12. <br />KI 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 />|X| Paper towels and pump-style soap container <br />13 <br />‘'important** <br />Completed by14. <br />Health Permit <br />=aosr Hanc Towels <br />Scan oisaer.ser <br />Propane Sieve <br />0T <br />ProMn': T.Jri' <br />3ieacn ana A'ater <br />Fire 5«Ttnquisner <br />Ice Cooler <br />TEMP EVENT APP <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />5? Three compartment sink. <br />5 Gai wane wash <br />Waatewater Coniainer <br />5-20 Gal <br />rtancl wash Water <br />Garbage <br />Can <br />Sammer ouc<et- <br />□leach i waler for <br />storing wiping EtOthS <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 />extra Ice Bags L Food Cantaioeri rnust be <br />stored 6 inches all al rhe ground’ <br />extra <br />Wat*' <br />Owner <br />Title <br />1/3/2023 <br />Date <br />=?inse Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />Mishael Moran <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I Sterio w/Chalfirg <br />Dish <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45DF (if food is used the following day. maintain below 41"F temperature): <br />® Ice chests K Refrigerator <br /> Refrigerated truck 55 Ice bath and tubs <br /> Other (specify)________ _ <br />l86St Hazelton Avenue } Stockton Califorma 95205 , T 209 468-3420 1 F 209 464-0138 I wwwsicehdcom <br />E HD 16-02 Page 6 of’I CVCN'1 <br />071'3/1? <br />LZJ_ <br />Scan .’'’c Wain- <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 />Mishael Moran_______ <br />Signature