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SAN JOAQUIN Environmental Health Department <br />my I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />FliNater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />F4ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Fp'aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />R EC-008 <br />NTY- <br />10. 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 followin , maintain below 41°F temperature): <br />Ice chests Refrigerator <br />Ilefrigerated truck Ice bath and tubs <br />IlOther (specify) <br />11.providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />hree compartment sink. <br />n <br />OR <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />r—ltion (one tablespoon of bleach per gallon of water). <br />I Detergent, bleach, and wiping cloths (cleaning towels). <br />7Tub to store wiping cloths in bleach solution. <br />**important" All food vendor b re subject to inspection. Please make a copy of this application in <br />preparation f A copy of this checklist must be in the booth at all hours of <br />preparation e urn original to festival coordinator three weeks prior to <br />this event. <br />Completed by: <br />Date <br />Health Permit <br />Sterno w/Challing <br />Oish <br />Bleach and Water <br />S Gal Nana wash <br />Wastewater Container <br />E-20 Gal. <br />Hand wash Water <br />Cutting Board <br />Peopane Stove <br />t'AMIRVZTV , <br />Dam tce Begs & Food Com aP)ers must he <br />stored 6 inches off at the,graundi <br />Rinse Water <br />Raper Haiti 'Towels <br />Sanitizer laticket- <br />bleach &water tor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Garbage <br />Can <br />Soap dispenser <br />ExH.ra <br />Ice Cooler <br />1868 E. Hazefton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 .464-0138 I www.sigov.org/ehd El-IL) 16.02 Page 8 011 TEMP EVENT APP <br />06/19/19 <br />8 -O-5- SUBMIT CL.CX\ <br />Title Ignature