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REC-008 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />QV/ater supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />(j/One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />d/Paper towels and pump-style soap container. <br />13. <br />X * <br />■•Important" <br />Completed by: 14. <br />Signature Title <br />Health Permit <br /> Paper Hand I awrts <br />Propane Steve <br />I <br />>JLFre Ertinourihefa <br />Ice Cooler <br />Names of responsible persons Io be present in booth dunng all hours of operation: <br />( <br />09/09/2025 <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />EZ/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 />Qtoetergent, bleach, and wiping cloths (cleaning towels). <br />G/Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />G/ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />£»tra t cRaQi 3 f ood Ccn:<w>c*j mjti tt <br />6 /KAea & If* ground^ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation lor this event. A copy of this checklist must be in lhe booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. ,------—— <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Stef no wChaiing <br />Dtsh <br />SGalHancl wash <br />WAMrmtw Cotnaiw <br />SdivLaw bucket <br />bteach A water io« <br />anxing wi&ng ckfhj <br />Garbage <br />Can <br />SAN JOAQUIN <br />------COUNTY------- <br />GreOtne« nrow* h<-rf <br />K _z <br />Rmw Watt <br />I Bleach <br />I ^rcpjnc Tajik J <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org ehd <br />EHD 16 02 PaQoSofll TEMP EVENT APP <br />0619^’9 <br />I Cvtl'KJ Buarti I <br />I | Btoach and Watc* <br />A <br />I Soap and Waler I I