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SAN JOAQUIN Environmental Health Department <br />11. <br />OR <br />12. <br />Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Paper Hartd Towels <br />Soap dispenser <br />Culling Board <br />Propane Stove Bleach <br />X <br />Rinse Waler <br />Piro ExtinguisherQ <br />Ice Cooler <br />51 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 />Slorno w/Chaff ng <br />Dish <br />6 Gal Hand wash <br />Waslewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Exira Ice Bar/s & Food Containers must be <br />stored 6 inches ot! of the gnxndl <br />Extra <br />Water <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Mariana Rpjar__________________________________________________________________ <br />10. <br />**lmportant** <br />Propane Tan-c <br />J: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwwsjcehd com <br />Page 8 of 11 TEMP kvENT APP <br />6/18/26 <br />Date <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 v/iping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[^] Three compartment sink. <br />/' (■’t SAN JOAQUIN <br />'7 -----COUNTY----- <br />■’ GrerHness r/rows here. <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 /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />Ail 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 />^Sighat^/e- <br />Health Permit I <br />'-T <br />Soap and Waler <br />... <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: 1 <br />Owner______ <br />Title