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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />my <br />13. <br /> <br />T <br />14.Completed by: <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />.J <br />Ice Cooler <br />Page 8 of 11 <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5-20 Gal. <br />Hand wash Water <br />f Extra \ <br />I Water I <br />_4_____ IziA7 <br />Rinse Water <br />Ion container with spigot). <br />‘‘Important**All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. “ <br />preparation and operation. <br />this eventTTz* <br />eJd ?6^2 Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 Pa9S 8 °f 11 TEMP EVENT APR <br />=7L I <br />[ Health Permit <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 galf <br />O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsibl^persons to be present in booth during all hours of operation- <br />Propane Tank ------------ <br />A copy of this checklist must be in the booth at all hours of <br />Return-original to festival coordinator three weeks prior to <br /> <br />Title Date <br />SAN JOAQUIN <br />------COUNTY------ <br />j Greatness grows hsie. <br />XHce chests [J Refrigerator <br /> Refrigerated truck Q Ice bath and tubs <br /> Other (specify) <br />jaifer. - . J <br />Soap and Water <br />^providing the following for adequate hand washing facilities, but separate from utensil wash within <br />□ ^hree co^partr^ent^ink ^emS Cleaning of food Preparation utensil <br />^HnTnnZT’hi1'1’8 (basi^ 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 />ub to store wiping cloths in bleach solution. <br />Booth must be on <br />Concrete, Asphalt, <br />feSglFl Plywood, or a Tarp, <br />..... ■..rf. ■ <br />Garbage <br />Can