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Signature <br />Stemo vs/Chaffing <br />Dish <br />Cutting Board <br />Pror—ne Stove <br />Propane Tank <br />Rinse Water Bleach and Water <br />Ice Cooler <br />L..-• e.• <br />Extra Ice Bags & Food Containers must be <br />stored 6 mches off of the ground , <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood. or a Tarp <br />Garbage <br />Can <br />SAN iJOAQUIN <br />nligkr COUNTY-- <br />Agin.' <br />Environmental Health Department <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />I <br />F 4 ' (if food is used the following day, maintain below 41 -F temperature): <br />chests ['Refrigerator <br />El Refrigerated truck 0 Ice bath and tubs <br />D Other (specify) <br /> <br />11 I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink <br />E-A/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 />abetergent, bleach, and wiping cloths (cleaning towels). <br />5-2/tub to store wiping cloths in bleach solution. <br /> <br />12. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth - <br />Water supply dispenser with warm water at a minimum of 100F (i.e. 5-20 gallon container with spigot). <br />W/One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />1E/Paper towels and pump-style soap container. <br />e of responsible persons to e present-in booth during all hours of operation: <br />iif\A -tct—if\A <br />OR <br />13 N <br /> <br />, <br /> <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 <br />et- <br />Paper Hand Towels <br />Sanituer bucket- <br />bleach & water for <br />storing wiping cloths <br />—Important- <br />14. Completed by <br />Health Permit <br />01,071-(Le- <br />Title <br />it <br />Dat <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />0612912023