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f <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />53 Water supply dispenser witn warm waier at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />EXOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />53 Paper towels and pump-style soap container. <br />13. <br />"Important** <br />Completed by:14. <br />Papo< Hand T owo<« <br />Soap dispo w <br />Culling Board <br />BlcacnPropane Stove <br />I <br />Prosane Tank <br />Bloacb arzf Water <br />F»o Extingmibor0 <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 />53 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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 />Stephanie Jackson________________________________ <br />Extra <br />Water <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Stereo wTChoffing <br />PWI <br />5 Gal Hand wasT <br />Wa*lewato< Contamer <br />Sanitizer Pocket- <br />MoarJi 4 waler for <br />ktonng wiping cloth* <br />Garbage <br />Can <br />Ice Cooler <br />IZ <br />SANJOAOUIN <br />------COUNTY— <br />G'cotness qrowS here <br />r <br />Rinse Water <br />J <br />Soap and Waler <br />Ftt’a ke Bags t Food Contarttrt miibt n <br />uored 6 nches oHottr* g-oimd' Bll <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 />53 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 />Kl Detergent, bleach, and wiping cloths (cleaning towels). <br />£3) Tub to store wiping cloths in bleach solution. <br />S-20 Gal <br />Hand wash Waler <br />10/Q1/2026 <br />Date <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this evepL A copy of this checklist must be in the booth at all hours of <br />preparation and operatidnARetum original to festival cc ydinator three weeks prior to <br />A Owner <br />’ (signatured Title <br />| Health Permit