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> 11 <br />10. <br />11. <br />OR <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Signature <br />Health Permit <br />1 Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Bleach <br />Propane Stove <br />I-ire Extinguisher <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches offol the ground! <br />Stemo w/Chatfing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Propane Tank <br />/ <br />L <br />Soap and Water Rinse Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />< ____________ <br />one for rinsing and one for a bleach <br />**lmportant** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[D^/Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />£opy of this checklist must be in the booth at all hours of <br />iturn original to festival coordinator three weeks prior to <br />Title Date <br />------COUNTY------- <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 />05ce chests EJ 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 />IpThree compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, <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 />=4^ <br />Names of responsible persons to be present in booth during all hours of operation: <br />Aryte/I---------------------------------------------------------------------------- <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. Acopy <br />preparatiorpapd operation-^ffit— <br />this ev< <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov_org/elhd <br />Q • C-lVIi LVLIi 1 /'IEHD 16-02 Page 8 of 11 <br />06/29/2023