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10.I am <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.v <br />Signature <br />Feoer Harxi Towels <br />Soap droensc’JCutlinj Board <br />SI eachFtupune S'.O-rtr <br />I <br />Propane Ter* <br />Bleach and Vt'sta <br />Fre EolffMjuishiSf <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />0 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 />5 Gai Hand wash <br />Waslewawr Ccnianw <br />Garbage <br />Can <br />Sooth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />ividing the following cold temperature control for the cold holding of potentially hazardous foods below <br />F (if food is used the following day, maintain below 41T temperature): <br />O Ice chests O Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_____________________________________________ <br />Slt<no w.t.latr.rx] <br />5-ZO Gal <br />Hand 'wash Wale: <br />Saritrcr bucket- <br />ttea-th & waler lor <br />swring wiping dcths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />j/JWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />water <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 />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event, x q <br />DateTitle <br />BXTra fC9 e»SS 5 Foor? Confaws musl CO <br />sSorod S radwa off of tfw grocmdJ <br />z <br />Soap and Water Rinse Water <br />/1 .»> <br />V n 11 j \j n v \j ( i i <br />------COUN“v------- <br />**lm portant** <br />Names of responsible persons to be present in booth during all hours of operation: <br />Ut k -• >______\ 1 < _________________________________________________ <br />- ■;r yrmry; <br />Health Permit <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 3 of 11 TEMP EVENT APP <br />G6Q9/2023