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» <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />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 />[J Paper towels and pump-style soap con^r.wash sink with hot wat;er in food truxin <br />13. <br />•’Important** <br />Completed by:14.Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 3 iBleachPropane Stove <br />Propane Tank <br />Piro Pxtmqulsher <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />Exfra Ice Bags & Food Containers must be <br />stored S mchos otf of the groundl <br />Slerno w/Chntfing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bnckel- <br />bleach & water for <br />storing wiping doths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <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 />Gary Blanco <br />5-20 Gal <br />Hand wash Waler <br />Garbage <br />Can <br />SAN JOAQUIN <br />-----C O U N “ v - <br />Owner <br />Title <br />/ <br />Rinse Water <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 />__1 <br />Soap and Waler <br />3 U 0 <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 />f] Refrigerated truck Ice bath and tubs <br /> Other (specify)___________________ <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 />th iS/ev^nlz^^^ 12/3/2024 <br />Signature <br />1368 E Hnzeltnn Avenue I Stockton Califoi-n'a 95205 | T 209 463-3420 1 F 209 464-0138 1 vww sjgGv org/ehd <br />EHD 16-02 ' Page 8 of 11 TEMP EVEN TAPP <br />06/29/2023 <br />--------------------- <br />Health Permit