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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />EZ Water supply dispenser with warm water at a minimum of 1C<3*F (i.e. 5-20 galcn container wth so-god. <br />[_/ One separate tub (bucket or basinj for the collectcn of rmse.%vastewater. <br />Q Rape- tcwe.s and cumc-style soap container. <br />13. <br />^Important** <br />Owner14.Completes by: <br />Title <br />Sli-13 -.Lruilnj <br />P.ip*< Wire T:*»» <br />CkKr^ U»a <br />Piaairi St..» <br />I <br />Ice Cooler <br />£s.M JL food CulkWl .TL4! t« <br />ikivd t o.'l erfm gnk«a< <br />I am providing the folky/zing items within my booth fo'the santary cleaning of food prepa-ation utensi <br /> Three compartmen1 sink. <br />I am provc ng the fa owing for adequate hand -^ashing fadTrties, but separate from utensil wash within my <br />booth: <br />i i-uras A>u-i <br />Ccru»>4>- <br />Hill KIM Vi'MIl <br />must te an <br />Concrete Asphafc <br />Fi/.vood, or a TaTJ. <br />I am providing the following cold temperature control for the odd holding of potentially hazardous foods beow <br />45eF (if food is used the following day. ma "tain below 41®F temperature): <br />Q Ice chests Refrigerator <br /> Refogeratec truck Ice bath and tubs <br /> Other (specify) <br />Gartafle <br />Can <br />tuiwt <br />tuocr k i3T <br />U311] KfalJ CktU <br />SAN JOAQUIN <br />COUNTY <br />7/4/26 <br />Date <br />I Pt.^xk->* Tm-k <br />All food vendor boot"s are subject to inspection. Please make a copy of this appl cation in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />prepa'atio?ā€™ and operation. Return original to festival coordinator three weeks prior to <br />Signature <br />[^Z~hree deep tubs (has ns 6-8 inches m nimum), one for soapy water, one for rinsing and one for a bleach <br />sotation (one tables coon of bleach per ga on of water). <br />HZ Detergent, beach, and wiprg cloths (ceaning towels}. <br />0 Tub to store wiping cloths in bleach solution. <br />Names of resconsio e persons to be prase"! in booth during all hours of operation: <br />Loud Ibanez <br />| Health Permit | <br />5 <br />f II Cahl^iU-ril <br />1B6BE Haze ton Avenue I Stockton. California 95205 I T 2(W 468-3420 I F 209464-0138 www.sjgov.org/ehd <br />tt-u W4X2 iā€˜i^» b ui ā–  i i twi* ev£H r AJTGr.U1-JC25 <br />fl Met .Vrl '.ā€˜.All- j |