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Environmental Health Department <br />eft <br />10. <br />11. <br />OR <br />12. <br />S'Water supply dispenserwithwarm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />QOne separate tub (bucket orbasin) forthe collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />Completed by:14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Soap and Water Rinse Water <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Cortainer <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket- <br />Ueach & water for <br />storing wiping cloths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Extra <br />Water <br />SAN JOAQUIN <br />-----COUNTY------- <br />Grecrtness grws here. <br />I am providing the following cold temperature control forthe cold holding of potentially hazardous foods below <br />45°? (if food is used the following day, maintain below 41 °F temperature): <br />Q*1ce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)____________________ <br />Chef/Owner <br />Title <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD16-02 Page8of11 TEMP EVENT APR <br />06/19/19 <br />Garbage <br />Can <br />04/08/2022 <br />Date <br />I am providing thefollowing items within my booth forthe sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />S^Three deep tubs (basins 6-8 inches minimum), one for soapy water, one forrinsing and one fora bleach <br />solution (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />Q'Tub to store wiping cloths in bleach solution. <br />“Important** 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 boothat all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event- <br />Darryn Aqsalda________ <br />Signature <br />---------dIce Cooler <br />Propane Tank <br />------------------------------i <br />Booth must be on <br />Concrete, Asphalt, <br />gF Plywood, ora Tarp, <br />x. ____ ________