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Environmental Health Department <br />10 <br />11. <br />OR <br />12. <br />13 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />SxPaper towels and pump-style soap container. <br />13. <br />••Important- <br />this evei <br />Completed by:14. <br />Sl| <br />Health Permit <br />hwrHrdTcwW <br />So«<tac*iMr <br />Propane Skna <br />BtoKT. and VMv <br />FnEjdntMtfw <br />Ice Cooler <br />TEMPEVtNTAPP <br />Scanned with CamScanner <br />Exffa fca Bap* C Food Cariman mat ba <br />Kind a nctiaa c/Idtba ground! <br />M 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 an hours of <br />preparation'aQd operation. Return original to festival coordinator three weeks prior to <br />SJarro «^OHffrTQ <br />Dst> <br />Em <br />WK* <br />SGaiHandansn <br />Contaaw <br />S20 GM <br />Garbage <br />Can <br />Sanfiar butaat- <br />bKacft&vMrfcr <br />ccnng w%mg ctor* <br />present in booth during an hours of operation: <br />I UUjbM <br />I am providing the following for adequate hand washing facSties, but separate from utensil wash wflhin my <br />booth: <br />''S Water supply dispenser with warm water at a minimum of 1 DOT (te. 5-20 gallon container with spigot). <br />Title <br />Soap and VMor <br />—Booth must be on <br />Concrete. AsphaA. <br />Plywood, or ■ Tarp. <br />Date <br />I am providing the fdtowing items within my booth for the sanitary cleaning of food preparation utensi <br />Q Three compartment sink. <br /> Three deep tubs (basins 6-8 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping doths tn bleach solution. <br />SAN JOAQUIN <br />----COUNTY — <br />G .-m-cm arrtM I’t"- <br />I am providng the foflcwing cold temperature control for the cold hokJmg of potentially hazardous foods below <br />45T toed Is used the fWtowing day, maintain below 41T temperature): <br />Q Icechests □Refrigerator <br /> Refiverated tuck Ice bath and tubs <br /> Other (speofy)---------------------------------------------------------------------------------- - <br />Names of responsible persons to be p <br />1868 £ Hazelton Avenue | Stockton, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD16-02 PapeBoTII TH" EVSHT A! <br />0TAV202S <br />r±_, <br />Rr—WW* | <br />I ClCnoBovd