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Environmental Health Department <br />10 <br />11 <br />OR <br />12. <br />Fj 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 rmse/wastewater. <br />@ Paper towels and pump-style soap container. <br />13. <br />••Important’* <br />Completed by: 14. <br />Health Permit <br />1 tlwx* T oocb <br />I--* <br />t (>4l ILU.1 <br />Vi rd. a i.<>i < emlsrv' <br />Ice Cooler <br />I am providing the following items within my booth lor the sanitary cleaning of food preparation utensil <br />Q Three compartment sink <br />Garbage <br />Can <br />txxkn <br />tuejch & •.ur< Kx <br />Woro-^ <<«>» <br />Booth must be on <br />Concrete >\spb.»t <br />Pl>v<ood or a Tarp <br />I am providing the following cold temperature control lor the cold folding 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 />[ i Refrigerated truck Q Ice bath and tubs <br /> Other (specify)--------------------------------------------------------------------------------------------------------------------------- <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 wiping cloths (cleaning towels) <br />E 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 />Sl»>ro wt.h*n.r.j <br />Orth <br />ra/wl iJI Vw <br />SAN JOAQUIN <br />COHNTv <br />Names of responsible persons to bejjresent in booth during all hours of operation; <br />|V\fVK)TI-- H_____________ <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 />Signature Title <br />r <br />09/18/2024 <br />Date <br />and <br />I«• I I <br />1868 E Hazelton Avenue | Stockton Californi.i‘15205 | T 209 468 3420 1 F 209 464 0138 | www sjgov oig vhd <br />tHO 1602 Page B <4 11 TEMP EVENT APP <br />G6-7U70ZJ <br />S 20 GS <br />r - H.iml wjvh Watr* <br />Sojpdrtccwrl --------- \ <br /> <br />=1