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Environmental Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />13. <br />Important** <br />Completed by:14. <br />Signature <br />Health Permit <br />1 Paper Hand Tnwoh <br />llleachPropane Stove <br />Propono Ton*. <br />Blench mid Water <br />Ice Cooler <br />TEMP EVENT APP <br />Stcmoiv.'ChMGno <br />Orth <br />Extra <br />Water <br />& Cal Hand wash <br />Wnstowalcr Container <br />Garbage <br />Can <br />Booth most be on <br />Concroto, Asphalt. <br />Plywood, or a Tarp. <br />L'tlin lev llntji X rnoil Coiitvhicri rrirrsl bu <br />storod C Inchlrt oil ot Iho groundl <br />5 ?0 Gal <br />Hand wash Waler <br />SAN JOAQUIN <br /><. Cju r 11 v <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink. <br />PJ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Qz] Paper towels and pump-style soap container. <br />r^:pj)^s^|2|^rsons lo be PreSGn, in boo,h dur'n9 al1 hours of operation: <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />CHO 1C.O2 PaflO B of 11 TEMP EVENT A! <br />06/19/19 <br />nX__Z <br />So.ip nnd Waler <br />V <br />It-nxe Waler <br />0 Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 />0 Waler supply dispenser with warm water at a minimum of 100’F (i.o. 5-20 gallon container with spigot). <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 />0 Ice chests 0 Refrigerator <br />0 Refrigerated truck O Ice bath and tubs <br /> Other (specify)_________ ___________—------ --------------------------------------------------------- <br />Eno Extlnqurthcr | <br />I Soap ditticmoi | ----------] <br />abo <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 bo in the booth al all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior, to <br />Enache own 09/08/21 <br />Title Date <br />S-imtum bucknt- <br />bleach A waler lot <br />tlodng wiping ckrtht <br />CutVnn Hoard