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Environmental Health Department <br />10. <br />11. <br />OR <br />12 <br />55 Water supply dispenser wrth warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />Bl One separate tub (bucket or basin) for the collection of rinse'wastewater <br />KI Paper towels and pump-style soap container <br />13. <br />••Important'* <br />Completed by:14. <br />Har»| <br />Sr:-* <br />Prapare SlDv* <br />ar»: war <br />F-e LAfQJSK- <br />Ice Cooler 5 Gat Hand <br />Waairfwwef Cc*«9inH <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink <br />Garbagr; <br />Can <br />here <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 />53 Ice chests O Refrigerator <br />O Refrigerated truck Q Ice bath and tubs <br />O Other (specify) <br />Dfib <br />frTO Gal <br />Hund Wotr <br />btojc? 1 tar <br />af&ng <br />Names of responsible persons to be present m booth dunng all hours of operation: <br />Cristian C Donato and Guadalupe Jimenez____________ <br />f <br />SAN JOAQUIN <br />-----COUNTY <br />Owner <br />Title <br />fjiru lor burj-j A Foua Cornnffa mus? bu I <br />I UKved fl inrMj 9* <br />Soac rirxl Wsie* <br />06/05/2023 <br />Date <br />KI 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 />KI Detergent, bleach, and wiping cloths (cleaning towels) <br />K Tub to store wiping cloths in bleach solution <br />All food vendor booths are subject to inspection Please make a copy of this application m <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 />Cy. fcAfaivi c Atrut - Tt*. <br />Signature <br />1868 E . Hazelton Avenue | Stockton, California 95205 I T 209 468-34201 F 209 464-0138 | wwwsjgov.org/ehd <br />EHD 16 02 Page 8 o< 11 TEMP EVENT APP <br />06'19.13 <br />| Health Permit <br />Booth must be or. <br />Concrete Asphah <br />Plywood, or a Tarp <br />___________J