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Environmental Health Department <br />10. <br />11. <br />for rinsing and one for a bleachOR <br />separate from utensil wash within my <br />12. <br />13. <br />‘‘Important** <br />14. <br />I I loalth Permit |« <br />| Soap dlsponsor | <br />| lUoach <br />Piopmio Stow <br />Ice Cooler !> Gnl I land wash <br />W.iMowator Containor <br />Gntbago <br />Con <br />Slorno w/CImftno <br />Dish <br />Sanitizor buckot- <br />blonch A water lor <br />storing wiping clotlis <br />| | Hlnso Motor [ | IMoadi nod Motor <br />f-------L Booth must be on <br />I......./] Concrolo, Asphalt, <br />L__I 'lywood, or a Tarp. <br />' ■ ■ ___________________________..ft. <br />f’nportlnnd lowols <br />| Culbnn llonril | <br />■”IV; <br />SAN JOAQUIN <br />COUNIY <br />I am providing tho following cold temperature control fordhe.cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 F temperature). <br />^Ice chests □Refrigerator <br /> Refrigerated truck LI Icc bath and tubs <br /> Other (specify)—----- ---------------------------------------------- <br /> Throe deep tubs (basins 6-8 inches minimum) one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water) <br />I l Detergent, bleach, and wiping cloths (cleaning towels). <br />| l Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but <br />booth: <br />| Piup.tno I ft'k r....^3 <br />Uro I xtinyiilstior <br />- 269 468-342.61 F 209 464-0138 | www.^ehd.|C«n <br />I ’ago B of 11 <br />1 i^lcollngsiloocIConMnotsniusIbo N <br />stored 6 Inchos alt ol the gmundl J 1 <br />1868 IT I lazelton Avenue | Stockton, California <br />I III) 10 02 <br />07/3/17 <br />Q Water supply dispenser wth warm water at a minimum of 100T (i.e. 5-20 gatlon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />|y[ Paper towels and pumprstyle soap, container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />M/hh d ----------—---------------— ~ <br />Ail £ <br />^^ion and operation: ^^iginaLtoJ-^ <br />this event. t ' fc <br />Completed by: -------"“^^TKie ’ Dato <br />5-20 Gal <br />Hand wash Water