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<br />Environmental Health Department <br />10. <br />12. <br />13. <br />“Important** <br />Completed by:14. <br />i <br />[Papsr Hand T (M«u <br />Soap dips ns er <br />Proptne Stove <br /> <br />.1 <br />Bleach and Wales <br />Fire Extngvshor <br />| <br />Ice Cooler <br />!■ <br />Extra fee Bags i Food Containers must be <br />stored 6 Inches oh d the ground <br />Exira <br />Water <br />5 Gal Hand wash <br />Waslewatar Conialnar <br />Sonitar bucket- <br />Neacti a water for <br />elorfng wiping clolhs <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp. <br />Garbage <br />Can <br />Stemo w/Chatf<>g <br />Dt»»> <br />Title <br />07/01/2026 <br />'Date <br />0 <br />J <br />| Bleach <br />Soap and Waler <br />? <br />Health Permit [•J <br />I Culbng Boaid I <br />f k’i tel <br />5-20 Gal <br />r- Bond wash Waler <br /> <br />£ <br />boothPr°Vldin9 tlie fo,l°Win9 for adeclua,e hand washing facilities, but separate from utensil wash within my <br />Names of responsible persons to be present in booth during all hours of operation: . <br /> ___________________/4-Ij55<\ f^r>~Z- <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 />___________/zZ/V <br />' Signature <br />mb/ t t <br />■ ' 7- ■ J? ■ ^-.7-:: <br />RiniB Waler <br />Propan* lank | <br />w <br />Water supply dispenser with warm water at a minimum of 100°F (i.e, 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Ixj Paper towels and pump-style soap container. <br />1868 E. Hazelton Avenue I Stockton, California 95205 [ T 209 468-3420] F 209 464-0138 | www.sjcehd.corn <br />EHD 16-02 Paaoeofli TEMP EVENT APP <br />07/3/17 ■ . ■ ’ . ■ . <br />J*"./ . .•’% ■" ”• *' 1 * . <br />■<7- V-/ 7:7... <br />11 ZXS ilei”s wi,hin l,,y b00"’for ths sanlla7clGanint’01,00d ”re'>ara,i0" <br />or' <br />'“"9 -e for a b.eaeb <br />B Detergent, bleach, and wiping cloths (cleaning towels) <br />B Tub to store wiping cloths in bleach solution. <br />SAN JOAQUIN <br /> - G Q U N T Y <br />t >/ rnl nr ,p , (. <br />*>’F (if food is used the following day/S Potentially hazardous foods below <br />^'ce chests □Refrigerator <br /> Refrigerated truck Ice balh and tubs <br /> Other (specify)