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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />facilities, but separate from utensil wash within my <br />13. <br />“Important** <br />14. <br /> <br />Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towelsj Soap dispenser 1 <br />Cutting Board <br />Propane Stove <br />Bleach <br />Propane Tank <br />fire Extinguisher <br />T 209 468-3420) F 209 464-0138 | <br />3 of 11 <br />45°F (if food is used the followim <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br />Garbage <br />Can <br />Sanitizer tmcket- <br />bieach & water for <br />storing wiping cloths <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />------COUNTY— <br />[ Extra \ <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp.__1 <br />Soap and Water Rinse Water <br />' a,T.“9 the “Id te^erature -ntrol for^e ™ing of potentially hazardous foods be.ow <br />Refrigerator <br /> Ice bath and tubs <br />• install hours of operation: <br />Bleach and Water <br />^ThZX^eS^8 Wi'hin b0°,b ,Or thS Sanit^ Clea™9 f°°< Preparation utensi! <br />Sufion FoXlXo^h!^ for water. one for rinsing and one for a hieach <br />LJ Detergent, bleach, and wiping cloths (cleaning towels). <br />LI I ub to store wiping cloths in bleach solution. <br />Stemo w/Chaffing <br />Dish <br />boo?hPrOVld'n9 thG f0ll0win9 for adecIuate hand washing <br />Water supply dispenser with warm water at a minimum of KOT (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 />Names of responsible persons to be present in booth durii <br />subject to inspection. Please make a <br />A copy of this checklist must be in the <br />| Ice Cooler <br />preparation"^ fhTXnT TiTpy^Xk^tX?^ 3 .X ‘his <br />Exira Ice Bags & Food Containers must be I <br />stored 6 inches ott ot the ground1 <br />ehd w-02 Haze,ton Avenue I Stockton, California 95205 | <br />06/19/19 Page 8 of 11