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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater <br />O Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />“Important* <br />Completed by: 14. <br />ign 'e <br />Health Permit <br />I*tip®i Hund I towuh <br />Soup <br />niwacnPfonun* Slow* <br />Ruiue WaUn BhHHti ar«l WaUrf <br />f if® EttllPQUIlVtOI <br />I II I ■m 42!11 <br />I <br />Soap til'd Wirtvi <br />Q 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 />0 Tub to store wiping cloths in bleach solution. <br />t-rtfn h;« A foot/ <br />akuwf n (Aff 0/ Itw yrtHjnrf1 <br />?• Gal Hand waah <br />Wmlnwalof Ccntuinvr <br />Garbage <br />Can <br />Saniliitti t>ucfcvl <br />bioudi A water tor <br />Mnvnp iMjitnq rlothw <br />Booth must bo on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <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 />O Ice chests O Refrigerator <br />[ Refrigerated truck O Ice bath and tubs <br />O Other (specify) <br />Sttrtnu w/Chulhftj <br />Di Uh J <br />Flit A <br />WaMn <br />20 Gal <br />Hand Waw <br />Ice Cooler <br />SAN JOAQUIN <br />- COUNTY------ <br />I are subject to ii <br />'ent. A cop' <br />ition. Retigd <br />PtiHRkiie funk <br />/r the <br />oriqjjl <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />ft Water supply dispenser with warm water at a minimum of 100"F (i.e. 5-20 gallon container with spigot). <br />nlon. Please make a copy of this application in <br /><checklist must be in the booth at all hours of <br />ral to festival coordinator three weeks prior to <br />Owner 11/14/23 <br />Title Date <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHD 16 02 Pago 8 of 11 TEMP EVENT APP <br />06/29/2023 <br />b)m providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />R Three compartment sink <br />Kristina Ruiz 1 <br />• 'll IV2VM »UI1UVI <br />preparation for thj <br />pr^aration and ■ <br />thWevent. / <br />Cuttwxi Board