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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />Completed by:Title14. <br />Health Permit Paper Hand Towels <br />Soap dispenser <br />Cuttina Board <br />Propane Stove <br />Propane Tank <br />Rinse Water <br />Ice Cooler <br />Page 8 of 11 <br />10. <br />' [ <br />1868 E. Hazelton Avenue I Stockton <br />EHD 16-02 <br />07/01/2025 <br />Garbage <br />Can <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />j 5 Gal Hand wash <br />| Wastewater Container <br />Soap and Water <br />Fire Extinguisher | <br />209 464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APP <br />**lmportant** <br />.California 95205 | T 209 468-3420 | F <br />□ »«• •—a,"‘” “ “** <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during,allhours of operation: <br />---------------------— <br />All (oca vendor tooths are ^i60' ™(Cbe6!. at aH hours of <br />this event. I , <br />Date <br />Signature <br />for rinsing and one for a bleach <br />Sanitizer bucket­ <br />bleach & water for I <br />storing wiping cloths I <br />SAimQUIN <br />------COUNTY------- <br />t .nntrol for the cold holding of potentially hazardous foods below <br />' TsT^food9iTus“o« below41‘Ftemperature): <br />fXce chests Refrigerator <br /> Refrigerated truck lce bath and tubS _______________ <br /> Other (specify)____ _____ <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum) one for soapy water, one <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 />, hVO.ldld. - — « — »- -«■« “ " ”»■“ ’ <br />booth: <br />Bleach