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10. <br />12. <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 /> Paper towels and pump-style soap container. <br />13. <br />•*lmportantM <br />14.Completed by: <br />Signature <br />1 Papwr Hand Towis <br />Cuftng Soa/d <br />Proparo Stovo Bloach <br />I <br />B'ooch and Waky <br />Flro Exdnnutjher <br />Ice Cooler <br />TEMP EVENT APP <br />Garbage <br />Can <br />Slamo wfCtufinq <br />Can <br />5 Gal Hand wash <br />Wnstowater Conlolnei <br />SsmczM b..KXnt- <br />tlwch A »stei Xy <br />stunog r«j dolru <br />SAN JOAQUIN <br />-----COUNTY <br />‘>'C<i(rir5< <j< ji \ bree <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 Ice bath and tubs <br /> Other (specify) <br />Environmental Health Department <br />Water I <br />Title <br />;~ <br />Health Permit ■' <br />_z <br />Soop and Water <br />11 ■ laniprovlding the following Items within my booth for the sanitary cleaning of food preparation utensil <br />©i hree compartment sink. <br />OR <br />ZZA Booth must bo on <br />/ Concrete. Asphalt. <br />—Plywood, or a Tarp <br />—_______/7 <br />Rinso Waler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 events*— <br /> <br />Date <br /> 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 Prapana Tonx <br />Edra Im Bagi a Food Cnntooen must bs P <br /> stood 6 inches altoltlwgroucdl <br />1868 E. Hazelion Avenue | Stockton. California 95205 [ T 209 468-34201 F 209 464-0138 I www.siqov.orq/ehd <br />PaaaBofH TEMP EVENT At <br />06/19/19 <br />WO Gal. <br />r- Hand woah Wale/ <br />I Soapdapcnset | ----------- \ <br />ibl <br />Names of responsiblp-persons tp-be present in booth during all hours of operation: <br />_____________________