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Environmental Health Department <br />10. <br />11. <br />12. <br />Waler supply dispenser weh warm waler at a nwwnum of 100*F (t o. 5*20 gaSon comaker with spigot) <br />13 <br />“ImportanT* <br />14.Compietodby: <br />Dale <br />Heath Pemut <br />MaM <br />ri <br />Ice Cooler <br />Scanned with CamScanner <br />cw> <br />WaaBvM* Cwwaai <br />VW GM <br />NWaai»««> <br />WM* MmcM* <br />MMaaa* <br />I am prowdaig the foikwwng items wthm my booth for foe sanitary cleaning of food preparation utensil <br /> Three compartment smk <br />I am provxkng the foBowmg for adequate hand washing teolfoes. but separate from utensil wash vefom my <br />booth: <br />GartMQ* <br />Cwi <br />BooSt muot boon <br />Cwwoto Aaphoa. <br />piywooe ora Tarp <br />I aMc» <br />SAN JOAQUIN <br />COUNT Y <br />G'rotnriv grpwv hf/f <br />I am prowdatg foe foUowvtg cold temperature control for foe cold hokkng of potenbaBy hazardous foods below <br />45*F (if food a used the foaowmg day. maintain below 41T temperature): <br />Ice chests *£) Refrigerator <br /> Refrigerated truck Ice bafo and tubs <br /> Other (specify) <br />• •«*m g* «T Me m®*'* pl <br />I <br />Names of responsible persons to be present m booth dunng al hours of operason <br />Michael Speer, lauren Pablo and katie brown <br />I RM I ——. <br />1&68 E Hazelton Avenue I Stockton. Cabforma 95205 | T 209 465-3420 1 F 209 464-0135 | www sjcehd com <br />f»<) *•»» •d’l TtMP CVtNT ASF <br />oro ir <br />I —I <br />S t <br />OR <br />H Three deep tubs (basins 6-5 inches rrwwmum). one for soapy water, one for rinsing and one for a bleach <br />Solution (one tablespoon of bleach per galon of waler) <br />Detergent, bleach, and w<Nng cfofos (cleaning towels). <br />Tub to store Wtoing Cloths in bieoch solution <br />Al food vendor booths are subject to mspecbon Please make a copy of fois appfccabon in <br />preparation for this event A copy of this checkksl must bo in foe booth al al hours of <br />preparation and operation Return original to fofflvai WQrfWto' 9^9 woefra prior fo <br />Owner June 5. 2019