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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14. <br />BJuachPrapanu Slava <br />1 <br />Prep ano Took <br />UloachaitrfWnler <br />MjOa <br />1 arn 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 />Garbage <br />Cail <br />Sanlnznr hucXel- <br />WBBchK <br />Btcriix] VHplno cloths <br />SWir.ow/Chalflno <br />Dish <br />5-2U GbI. <br />■J tnnd wash Wale, <br />i <br />l^lce Cooler <br /> Three deop tubs (basins 6-8 inches minimum), one for soapy wator, one for rinsing and one for a bleach <br />.solwllon (one tablespoon of bleach per'gallon of water). <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />'^LtTub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue J Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.coni <br />EHDIB-aa Page fl of 11 TEMP EVENT APP <br />07/3/17 <br />'-h <br />10.. <br />U_z_, <br />Rlnsft Wivor | <br />I Ijara A <br />Wslor <br />OwdiviptW' <br />™e odio <br />J fapwHmtf Twats j <br />**hnporfantA* <br />pmp <br />\\ thisj <br />Completed bydy$j^’ <br />Health Permit <br />3 Gu) llanil wash <br />Wastewater Cwilelnsr <br />SANJOAQUIN <br />-----COUNTY------ <br />/uni''"' Cp'otnusr ijraivs 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 41T temperature): <br /> loe thesis Refrigerator <br />D Refrigerated truck tee bath and tubs <br /> Other (specify). ______________________________ <br />C) Water supply dispenser witli Warm water at a minimum of 100°F (l.e. 5-20 gallon container with spigot)-, <br />^fono separate tub (bucket or basin) for the collection of rlnse/wastewater. <br /> Paper towels and oump-sfyle soap container. <br />Names of responsible persons to be present In booth during all hours of operation:K&hHCA ChSa^PlO_____ . <br />FIrti Extinguislwi I <br />I si»p iflspansor <br />i <br />J-e- <br />Soap sold Walnr <br />/ Exi/a lai Hous M'oixi CanloJners mu.'il ho <br />'' tloretl 6 inches ori ortho gmindl <br />Booth must bo on <br />Concrolo, Asphalt, <br />,S-—Plywood, or a Tarp. <br />All food vendor booths are subject to Inspection. Please mgke a copy of this application jn <br />prpPfiration/Jor this event. A copy of this checklist must be In the booth at all hours of <br />sp^ratlbfl rand operation. Return original to festival coordinator three wesks prior toa&_ <br />Signature