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Environmental Health De pa rime: <br />w <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />L_] One separate tub (bucket or basin) for the collection of nnse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Date <br />Health Permit <br />Pa|x>r Hand roawis <br />Soap dispenser <br />BleachPropa-v.- Stove <br />sb <br />Propane I ank <br />Bleach and Water <br />Fire Exttnauisher <br />I HU 16 02 <br />07/01/2025 <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 />® Ice chests Refrigerator <br /> Refrigerated truck ’0.lce bath and tubs <br /> Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink. <br />LI 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 /> 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 />Names of responsible persons to be present in booth during all hours of operation <br />yMCHAcL hAfiCArVD , <br />Ex/ra ice Bags & Food Containers must be <br />stored 6 inches olt ol the ground1 <br />Exira <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer txick ?l <br />bleach S water for <br />storing wiping clolb!; <br />Booth must be on <br />Concrete. Asohalt <br />Plywood ot a Tarp <br />Sterno w/Chaffrng <br />Dish <br />5-20 Gal <br />Hand wash Water <br />Ice Cooler <br />SAN JOAQUIN <br />C O U N T Y <br />OWNEP <br />Title <br />L <br />Soap and Waler Rinse Water <br />’.'oSF. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | www.Sjgov.org/el;c <br />Page 6 of 11 TEMP EVENT APP <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for thfis 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 />this event //a <br />________ ___________________OWNEP_________7/7 <br />/ Signature <br />Culling Board