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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 rmse/wastewater <br /> Paper towels and pump-style soap container <br />13 <br />•’Importanf <br />Completed by14 <br />Date <br />1 It <br />Proparw T <br />,1 Bloxtlara •'.a't <br />Fh© Etl ng jttntf <br />S G>. Ha^ wfl»n <br />AaV.eVij’.or Co -w «' <br />K <br />Title <br />Cir a I<-O S Footl mutt t>o <br />itMnJ f jkkc > o'! o' tM grw^' <br />Sixno «»Cr»<T "a <br />Dim <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />6»tra <br />Wata« <br />Garbage <br />Can <br />Booth must be 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 /> Ice chests Refrigerator <br /> Refrigerated truck EJ Ice bath and tubs <br /> Other (specify) <br />s«n bvc»«r <br />b'MCh S waler !Cf <br />VOnn.; w peg cell <br />S20 G* <br />Hana wain W»w <br />SAN JOAQUIN <br />-COUNTY <br />j Ice Cooler <br />I <br />Sc-ap ana Aaler W'nia .Vale' <br />tl <br />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 100 F (i e 5-20 gallon container with spigot) <br />0 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 items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink <br />Scap J Hwnife- I --------- - <br />I o K <br />sOo <br />All food vendor booths are subject to inspection Please make a copy of this application in <br />preparation for this event <br />preparation and operation <br />this event. ' <br />--------- - <br />Signature <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420) F 209 464-0138 | www sjgov org.'ehd <br />fHD 16<i? Page 8 Of 11 TEVP EVENT APP <br />06-25/2023 <br />Health Permit <br />Names of responsible persons to be present in bootlydunng all hours of operation <br />__________H c'tr ______________ <br />Opting Boa/O