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Environmental Health Department <br />OR <br />J Water supply dispenser with warm water at a minimum of 100°F (i.o. 5-20 gallon container with spigot). <br />Ono separate tub (bucket or basin) for the collection of rinse/wastewatcr. <br />13. <br />14. <br />| Health Permit <br />I| CiHIiig Hoard | ... . <br />/ <br />lea Cooler <br /> Three deep tubs (basins 6-0 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />IZI Detergent, bleach, and wiping cloths (cleaning towels). <br />I J Tub to store wiping cloths In bleach solution. <br />len Hags S I aod Gonlalaois muni bo ) <br />stored 0 Mies oil vl tho firomitll („ <br />|i (Jul llandwasli <br />W.istownlor Contillnor <br />(i.iihajjo <br />Can <br /> f- <br />Date <br />| [ lUnaoWMor | | Otonch imHVMof <br />D-20 <Jnl. | <br />IlnndwunltWntor I <br />| Soup cHsponsor3 ”]\ <br />t H <br />11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I I Three compartment sink. <br />TTm^r^dlh^th^TblPWlh^fdradd^ separate from-utehsil-vrastrwithin my <br />booth: <br />SANJOAQUIN <br />.....COUNTY -- <br />‘-i, „ Gi ('(itness <;roiv!. Ih.-iv <br />10. I am providing tho following cold temperature control for tho cold holding of potentially hazardous foods below <br />457- (if food Is used tho following day, maintain below 41T temperature): <br /> Ice chests O Refrigerator <br />[ | Refrigerated truck I. J Ice bath and tubs <br />[J Other (specify) <br />1868 l.:.. I kizellon Avenue | Stockton, California 95205 | T 209 468-3420 | I- 209 464 0138 | www.sjgov.org/ohd <br />UK) if, 02 Pnfio n of 11 TI MPIM^T app <br />06/10/PJ <br />| I’ropixio look <br />| I'roixvio Stovo | IMooch <br />V/l Paper towels and pump;stylp_soap. container. <br />Names of responsible persons tefbe present in booth during all hours of operation:_____7/^ J __________________________ <br /> **lmportant** 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 bo in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />Completed by: <br />Signature Title <br />.... | f’nporlloixl Towul.1 <br />/ I SniiKf/or Inickot- <br />/ I bloarh A w.itor for <br />/ / staling wtpliK) dottis <br />fZZ'...".:/} I booth must bo on <br />j I / Concfoto, Asphalt, <br />| .'ionp mid Wnlor <br />1 Iro f-xllnnolnlior | <br />Storno w/Chnfflng <br />DIMi