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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />‘•Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />Papt Hand Towaii <br />Soap d»p«n*«r <br />Cunnfl Boa-d <br />B«acnPropane Stove <br />If <br />Propane Ten* <br />BeecM and Water <br />Fee Extnaurener <br />Ice Cooler <br />Scanned with CamScanner <br />r". :L <br />Scap and Water <br />EHD 16-02 <br />07/01/2025 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Hand wa»h <br />V/astewater Contaner <br />Garbage <br />Can <br />IS.Water supply,dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />(S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q-Paper towels and pump-style soap container. <br />Stemo w/Chaffeo <br />D-Vt <br />Sanitizer bucxet- <br />bleach & water for <br />etoonfl w^<xj O«M <br />Vrtte- <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 />this event. --------i , <br /> <br />Title <br />I <br />Rr-ae Wrer <br />E*!r» Ice S»f s 4 Food Con.'aners ■ <br />Korea 6 off of tra t 'OurxT jj <br />SANJOAQUIN <br />------COUNTY------ <br />Greotncss grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45eF (if food is used the following day, maintain below 41 *F temperature): <br />j^Tlce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />_____ _________/ <br />5-20 G*l <br />Hand w«»h Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^jThree compartment sink. <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 /> Tub to store wiping cloths in bleach solution. <br />1668 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pace 8 of 11 TEMP EVENT APP