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I � <br /> }� t <br /> SAN JOAQUIN ["I'Mroli mofital Health Department <br /> 1`1 <br /> 10, tam i�'oviding ilia folinwing cold loltll ornturo control for thu(,0111 holdifig of polnrlllrllly Ilriinrdoun food© below <br /> 45'I'(lf food is umod Ilio foliawing tiny,tnnhllnIII Dhow 41"f lalnpurn(irrn): <br /> ice ch©Its itrhitlorntnr <br /> C1 Rcfdgrrnted tntok (:-.I Ica bulb and tubh <br /> C7 Otho <br /> 11, I am providing Ilio tollo►vtng itatlls within my boolh for 1ho runIlrny clowning of food preparation utensil <br /> ❑ <br /> OR Thm-0 MITI IMICtlt sink. <br /> ❑ Thr>ae deep tubs (basins 6-8 inches minimurn), one for soapy water, one for rinsing and one for a bleach <br /> SOWN)(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 /> 12. 1 am providing ilio following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ❑Water supply dispenser with warm water at a minimum of 100T(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. N e of responsible persons to be present in booth during all hours of operation: <br /> "Important" 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 virlor to <br /> this event. , <br /> 14. Completed by- "'2L'3 <br /> Signature Title Date <br /> Health Pefmlt 1lanawsshwa;cr <br /> Sumo M�Gleal&p y"' <br /> Desk <br /> rap"14M)4 Tvuef� <br /> Scrap IXfpOMOr <br /> C'w�bfq 09frG SanAaa b <br /> QW-9 WP"do" <br /> Booth must be on <br /> concrete.Asphalt. <br /> Ilywood,or a Tarp, <br /> tropane T art '''���'''III <br /> Soap aro W"<ol Ihm"War u rMeKn n,ul Wntar <br /> I Garbego <br /> rrer:iAinWrrer <br /> Cen <br /> litre <br /> 1 WNer <br /> )Ce Cooler } 56nr 1rand we dl <br /> r=airs rce flayf L 1'oael Cerl++ieN mufl6e WgftwnFw enm.}nve <br /> • sraed Q inches os N1he pret,mlr '� <br /> i8G8 E. Hazelton Avenue Stockton, California 952051 T 7.00 408-3420 1 F 209 46,1-0138 1 www sJgov arg/Chd <br /> L•Ho 75-02 PON 8 0141 TEMP EVENT APP <br /> OW 18719 <br />