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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100‘F (i.e 5-20 gallon container with spigot) <br />0 One separate tub (bucket or basin) lor the collection of nnse/wastewater <br />0 Paper towels and pump-sMe soap container <br />13. <br />"important** <br />14.owner <br />Titie <br />Health Permit <br />P»(>w Hana TmhM <br />PxMxn* Sk>v« <br />Rnu Maw ttiaaah and Waw <br />taUMMUha' <br />1868 E. Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov org'efid <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation <br />Jayna Casey. Bret Casey <br />Garbage <br />Can <br />(2 Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for nnsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water) <br />[x] Detergent, bleach, and wiping cloths (cleaning towels). <br />3 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 />4 CM Hana M« <br />MaOMMH uaraww <br />$a«U:M BwCkM <br />MtMlaMrla <br />tutta <br />t«*a <br />Out <br />Hunt *aanM««t <br />onature <br />Booth musl be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />ilH............. . <br />Ice Cooler <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 ail hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event. <br />Completed by: Jayna Casey 5-1-21 <br />Date <br />Tar* <br />--------------------------—J <br />£«>»*» •foodConmnw-u r* E <br />ait» grauno’ ■ <br />SANJOAOUm <br />COUNTY <br />X.. Grrotnesi grcwi <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41'F temperature): <br /> Ice chests Refrigerator N/A fof uS <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify)___ _______________________________________ _