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Environmental Health Department <br />11. <br />OR <br />12. <br />0 Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by:j14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleacli <br />Propane T ank <br />Soap end Waler Rinse Water <br />Fire Extinguisher0 <br />Ice Cooler <br />II <br />■ m r I <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 />Extra fcs Bags & Food Containers must be <br />stored 6 Inches otfotthe ground1 <br />Slemo w/Chatrng <br />Dish <br />Extra <br />Water <br />6 Gal Handwash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />bteach 6 water for <br />storing wiping cloths <br />10. <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Randy Harlan; Katie Harlan <br />SANJOAOUIN <br /> COUNTY------ <br />(>i col ness c/rows hcce. <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 0 Refrigerator <br />□ Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) ice cream freezer <br />5-20 Gal. <br />Hand wash Waler <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 />^anr^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />Bleach and Waler I fl <br />Jhd?An;Ha2elton Avenue 1 Stockton- California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />XT PageBoni TEMPEVENTAPP <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 />ereoaration and operation. Return original to festival coordinator three weeks prior to <br />thbrevettr I I f) ' <br /> coordinator 6/9/26 <br />Title Date <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp.