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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />**lmportant** <br />Completed by;14.DateTitleSignature <br />1 Paper Hand Towels <br />Soap dispenser <br />Cutting Soaro <br />Bleach <br />Propane Stove <br />Propane Tank <br />Fire Extinguisher <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Sterno w/Chafflng <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach i water for <br />storing wiping cloths <br />5-20 Gal <br />Hand wash Water <br />SAN JOAOUIN <br />------COUN'V -— <br />Ice Cooler <br />I am providing the <br />booth: <br />0 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 />Water <br />_____________- <br />Health Permit <br />_z <br />Soap and Water <br />Bl <br />Rinse Water <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hoursof operation: <br />1363 E. Hazelton Avenue | Stockton. Californ.a 95205 1 <br />EHD 16-02 r“'°‘ <br />06/29/2023 <br />____________________ <br />Exira Ice Bags & Food Containers must be I <br />stored 6 inche soft of the ground' I <br />All food vendor booths are <br />preparation for this event, <br />preparation and operation. <br />this event. <br />- 209 468-3420 1 F 209 464-0138 | v/w.v sjgov org ehd <br />Page 8 cf 11 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 the following day, maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br />I5( Refrigerated truck D Ice bath and tubs <br /> Other (specify)^--------------------------------- -------------------------------------------—------------------------------- - <br />r ind-vQ AlnnanA-z- -ft --------- <br />subject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[J Three compartment sink. <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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />following for adequate hand washing facilities, but separate from utensil wash within my