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REC-008 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />this event.Owner 07-20-202614.Completed by: <br />Title Date <br />] <br />Paper Hand Towels <br />Soap dispenser <br />CulUnfl Board <br />BleachPropane Slove <br />n pi <br />Propane Tank <br />Bleach and Water <br />Fre Extinguisher <br />Ice Cooler <br />4 <br />) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Q Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches oft of the ground1 <br />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 prior to <br />• ’wqned via GovOS com <br />Sterno w/Chaffing <br />Dish <br />Exira <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand washWater <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler lor <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, ora Tarp. <br />SAN JOAQUIN <br />-COUNTY <br />Greotness <br />Names of responsible persons to be present in booth during all hours of operation: <br />Katheleen Camarillo <br />Samantha Ouk <br />“Important** <br />---- Key: 7(lcSc7B# Gfll6-4ft.V-a3f.t-<ltfM2t>QlMiO ----- oiyiiaiuic; <br />r <br />Rinse Water <br />Q 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />5 Tub to store wiping cloths in bleach solution. <br />here <br />| Health Permit <br />—K. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16 02 Page 8 ol 11 TEMP EVENT APP <br />06/19/19 <br />rr EZ__Z <br />Soap and Water