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103 <br />11. <br />OR <br />12. <br />Names13. <br />“Important** <br />DateCompleted by:14.Title/Signature <br />Health Permit <br />Cutting Board <br />Propane Sto <br />Califo'T’’13 <br />0 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 />5-20 Gal <br />Hand wash Waler <br />Stemo w/Cnaffing <br />Dish <br />,-d .G3e <br />Can <br />•.•..vr-g ■■Jw •- <br />i <br />\ Booth must be on <br />I x-,r'70!- t-’-phaV <br />1 pt/.T xl or 3 <br />95205 I <br />Pag8 <br />; are subject to inspect,on. Please mate a copy 0' <br />/St A coov of this checklist must be tn the booth at a» hours oi ton ReZ original to festivalcoordinatoL^^ <br />nC .I -(> '■ J <br />y 2Q9 468'3420 I 1 <br />ectit <br />propa^s Tank <br />Environmental Health Department <br />□ Paper towels and pump-style soap container. <br />tsponsible persons to be present in booth during all hours of operation <br />□ "EX “n9k.i,emS Wi’hln my bOO,h f°r ’he S3nlt^ or toob preparation ute„511 <br />S r^o^? biS^pergZ'™^ “I"6 SMPy — <br />LJ Detergent, bleach, and wiping cloths (cleaning towels). <br />I—I Tub to store wiping cloths in bleach solution. <br />boothPrOV'd'n9 thG f0ll0W'n9 for adec^uate hand cashing facilities, but separate from utensil wash within mv <br />.,fJrynv <br />•. \ SAN JOAQUIN <br />.ZLzr -------COUNTY--------- <br />otcV*’'’ GrcnJnc groivs /ter® <br />- ‘ 45OF °f food i^used^foSn? dPeratUfe COn,ro' for the C°'d Ko'd,n9 o< potentially hazardous < <br />ffl Ice chests blowing day. maintain below 4VF temperature); y na2a^ous toorJs belo* <br />□ Refrigerated truck H Iceh9?^'^ <br />□ Other (specify) D and tubs <br />All food vendor booth' <br />preparation fpy this <br />preparatiorya/d/ppep* <br />this eventf- <br />// <br />nue | Stockton. <br />Soap C'soenser <br />Bleach <br />Rmse Water