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<br />Environmental Health Department <br />10 <br />11. <br />OR <br />12. <br />13. <br />r <br />"Important” <br />Completed by: 14. <br />Health Permit <br />P»p«r Hand Towels <br />Soap ciopeniicr <br />Ciittirq Board 1 9leadiPropare Stove <br />Propane Tank <br />Ploach and WjlerRinse Wate^Soap and Water <br />Fee Ejflrnuiitar <br />Ice Cooler <br />E Three deep tubs (basins 6-8 inches minimum), one (or soapy water, one for rinsing and one lor a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />U Detergent, bleach, and wiping cloths (cleaning towels). <br />PlTub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />ra^..a*:T.~_______— <br />Ejttra lea Bags i. Food Confwntfrs muai ba <br />stood 6 inchas of! cflbe gtcund1 <br />S-20 Gat. <br />Hand *34h Wj’er <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <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 4 TF temperature): <br />/Istfce chests ^EH^ofngerator <br /> Refrigerated truck Q Ice bath and tubs <br />O Other (specify) <br />Sle'no w^ChaTing <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />• <br />I <br />I <br />i <br />I <br />I <br />I <br />Date <br />SAN JOAQUIN <br />------COUNTY <br />- <br />Names of responsible persons to be present in booth during all hours of operation <br />yyywL ! <br />J^JWater 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 />£j Paper towels and pump-style soap container. <br />im <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 ail hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. 1 /; XA <br /> <br />Signature' <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />6 of 11 TEMP EVENT APP <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />s <br />J Title <br />Santtzer tudret <br />bleach & vra’er far <br />r UCffQ wiping defrs <br />/ r