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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dtsportticr <br />CuHhvj Board <br />Propane Stove <br />Propane Tank <br />Fue Emnquis.hr.-r <br />Ice Cooler <br />Slemo w/ChafFng <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br />Santtiznr t>ucket- <br />bteach & water for <br />stonng wiping cloths <br />5 Gai Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation- <br />pcXVV, vH, <br />•’Important <br />__ <br />Health Permit <br />1^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />' the f±uin^°ld temPerature controi f<>r cold holding of potentially hazardous foods below <br />4b r (if food is used the following day, maintain below 41 “F temperature): <br />0. Ice chests Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br />0 Other (specify) <br />□7hrTe cTm 'artml'T'Hk'temS W'th'n b°Oth thS San'tary cleanin9 °f food preparation utensil <br />£1 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 />ElWater supply dispenser with warm water at a minimum of 1 GOT (i.e. 5-20 gallon container with spigot). <br />'4~].Pne seParafe tub (bucket or basin) for the collection of rinse/wastewater. <br />.0 Paper towels and pump-style soap container. <br />www. sjgov.org/ehd <br />TEMP EVENT APP <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp, <br />.......1 ..... J <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. ' 1 ‘ ‘ “ <br />'' __________________ ; I.-• k..~(... <br />Signature Title Date <br />........ ....... . .. , _____ <br />Extra Ice liags & Food Conlatners must t>e f : <br />stored 6 inches off of the ground1 <br />Haze,ton Avenue j Stockton, California 95205 | T 2O9 46B-3420 F 209 464-0138 I <br />EFiLJ i ra o , 4 406/19/19 Page 8 of 11