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Environmental Health Department <br />10. <br />11. <br />OR <br />12 <br />13. <br />“Important** <br />14.Completed by: <br />SIgnatui <br />Paper Hard Towels <br />Cuffing Board 1Propane Stove <br />I XJU <br />Propane Tank <br />Bleach and Water <br />Fra Exllnpuishar <br />5 Gal Hand wash <br />Wastewalor Container <br />5-20 Gal. <br />Hand waah Waler <br />Garbage <br />Can <br />Stamo w/Chafflng <br />Olah <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Health Permit * <br />Sanilizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />SAN JOAQUIN <br />— COUNTY <br />PWer 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 />Draper towels and pump-style soap container. <br />/ Extra \ <br />Water <br />Title <br />Rinse V/ater <br />EL ce chests [ Refrigerator <br />□ Refrigerated truck Q Ice bath and tubs <br />□ Other (specify) <br />bSh:ProVidin9 tt’e fOllOWinS f°r ade<,uale hand wa5hin9 fac»i“es. but ^parate from utensil wash within my <br />r^cdX'XenUlnl“emS Wllh'n b00th 'Or Cleanir'9 df ,00d PrePara'™ ^"^il <br />,or soapy water'one for rinsing and one for a bleach <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />rrtI <br />Soap and Water <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 /> /-7^6 <br />Date <br />Names of responsible persons to be present in booth during all hours of operation- <br />■ S, /V( ________________________ ’ <br />Entra ka Btga A Food Containers ms be <br />Hondt ksebM of! otUM ground <br />EHD ?6^2 Ha2ellon Avenue I Stockton, California 95205 I T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />M/19/19 Paa° 8 0,11 TEMP EVENT APR <br />f-----Zi <br />Ice Cooler i I