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SAN 10A0UIN <br />foods below <br />10. <br />11. <br />OR <br />within mv <br />12. <br />13. <br />112.' <br />14.Signature <br />Pape' Hand TowelsHealth Permit <br />Soap dispense' <br />Cutting Boa'd <br />Bleach <br />propane Stove <br />TFs. I <br />Bleach and WalerRinse WaterSoap and Wale' <br />fee Extinqmshe' <br />Ice Cooler <br />Piopane Tanl1 ; <br />5 Gal Hand wash <br />Waslewalei Container <br />Garbage <br />Can <br />E/tiu Ko ttuys i food ConluiiiB'i must bo <br />t.lcetl 6 Mic/ies oil ol U’o giouMil <br />Sterno w/ChaWing <br />Dish <br />Sanitize' Budcet- <br />bleach & water tor <br />storing wiping cloins <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />1868 E <br />EHP »b-<* <br />07/01/2025 <br />5-20 Gal <br />Hand wash Wale' <br />I <br />Environmental Health Department <br />I am provid.no iho fellowing cold temperature/^‘r^4rF temperature) <br />45T (it food i>. ufi3d ih0 following day, maintain <br />Behests Refrigerator <br /> Refngeram-.-.t-h Q Ice bath and tubs <br /> Other (sp- <br />cold holding O' potentially haza'^ <br />from utensil wash <br />Hazelton Aventie | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 8 ot 11 TEMP EVENT APP <br />ATfoST^d^ooths are checklist must be in the <br />fhis ft' • ______ <br />Completed by:------ f-T Title <br />for rinsing dr, • <br />3 bleach <br />f lhe sanitary cleanin9 <br />I am providir'-- following items within my booth <br />r~l Three co ■ ceudment sink <br />Q^store wiping cloths m bleach so u . <br />I am provide lhe loHowing tor adequate hand washing <br />b00,h' f inn°F (i.e. 5-20 gallon container with spigo <br />B'wZter supply dispenser with warm water al a minimum <br />Ql^per towels and eyminstylesoae container. <br />Names of^esjynsibtej.erso^e <br />Date <br />Eatra <br />Water