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SAN JOAQUIN Environmental Health Department <br />10 <br />11. <br />0« <br />12 <br />Wartw supply dispenser with warm water at a mirwnum of 10CT (i e 5-20 gaton container with spigot) <br />£3 One separate tub (bucket or basin) for the cotecbon of rmsa/wastewater <br />13. <br />-Important- <br />14 Compieted by <br />Hearth Permit <br />am <br />mm* !*• <br />IMacn »v *»• <br />■«itw Vr Bags ( AoM *• <br />• <w»h o*« aw <br />DM <br />5/0 <br />Mwr <br />UaUr aufl <br />am.n * <m*v h» <br />aaan««i wjanc oopa <br />Haaaimi- <br />Mammr Cnnaawa* <br />I <br />fcHD IS43C <br />Or n-17 <br />I am providing the foltowing for adequate hand washing fociMes. but separate from utensi wash wrthm my <br />booth <br />I am providing the fafiowing cold temperature control for the cold hoidmg of potenaarty hazardous foods befow <br />45T (if food is used the taSowing day. mafotain below 41 °F temperature) <br />Q foe chests Refrigerator <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify)_________________________________________ <br />5 <br />01 Three deep tube (basins 6-8 inches minimum), one for soapy water one for nmmg and one for a bteach <br />solution (one tablespoon of btoch per gallon of waler) <br />^Detergent bleach, and wiping cloths (deamng towels) <br />Q Tito to store wiping cloths to bteach solution <br />OartMQS <br />Can <br />Booth rmrrt be an <br />Conewte. Aapnail. <br />RywKMl. or a Tarp <br />! Ice Cooler <br />Si y, fn. t ‘TFr ____________ <br />Al food vendor booths are subject to inspecbon Please make a copy of this application in <br />preparation for this event A copy of this checklist must be to the booth at ail hours of <br />preparatjon and operation Return ortatnal to festtval coordinator three weeks prior to <br />this event <br />Tide <br />1_2£l2£1» <br />Date <br />I am providing the fdlowing items within my booth for the sanitary cleaning of food preparation mens! <br /> Three compartment smk. <br />Name® of responsibte persons to be present m booth during al hours of operation <br />I flbwr—r <br />1868 E Howerton Avenue | StocMon. California 95205 | T 206 468-34201 F 209 464-0138 ( www sjcehd com <br />--^^2 RlsMani THMPEV^NTAPF