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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />® Water supply dispenser with warm water at a minimum of 100eF (i.e. 5-20 gallon container with spigot) <br />23 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />® Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Date <br />Paper HarKI Ttswets <br />Pmpane Sieve <br />I am. <br />ttieaci: and aterftrsse fc’ysterSoap and <br />F«?e £xynauis.ncr <br />Ice Cooler <br />jXj 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). t <br /> Tub 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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />SlemG •tChatffmgi <br />Garbage <br />Can <br />Names of responsible persons to be present in booth during all hours of operation: <br />Janeen and/or Jeff Tapiin <br />AH 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 />4/20/2021 <br />£.«ra <br />Waaer <br />5 Gai Hand uvasr <br />Aasteawitor Cansoner <br />Sarvteftf &ucke« <br />& water <br />siairrg casihs- <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood. or a Tasp. <br />5.2a <br />Mana t’raw <br />SANJOAOUIN <br />—-COUNTY— <br />Greetnes* arews h^rf <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 />® Ice chests Q Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />O Other (specify)....................................................... , <br />"Important** <br />Owner <br />TitfeSignature <br />™■“——■B—-| <br />jEjctns see Sags 4 Food Ckxitaere^s toe |c. <br />1868 E. Hazelton Avenue ! Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 j www.sjgov.org/ehd <br />fan PsueB.afl.1 T£Mp WT APP <br />j Health Permit t