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Environmental Health Department <br />11. <br />OR <br />12. <br />® Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br /> - <br />14. <br />Signature Title Date <br />i Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />Rinse Water <br />Fire Extinguishera <br />Ice Cooler <br />[Xl Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />® One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra /co Bags i Food Containers must bo <br />stored 6 inches oil ol the ground! <br />Slo.-no w/ChalFng <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />T:-1 t ( <br />Lfftici? 0hawP7 <br />“Important** <br />Soap and Water <br />Health Permit I <br />Propane T ank <br />-----------------------S <br />5-20 Gal. <br />Hand wash Water <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />-^1 <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 all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />Completed by: Leticia Chavez <br />Ki 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />[ Bleach <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />/SANJQAQUIN <br />•/’.U-'}*:. ■'/ ------COUNTY— <br />■■ /• <br />' ' Greol ness c/rotvs het e. <br />10. lam 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 />(3 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />nv,?,,1,6’02 Pa9°8 °r 11 TEMP EVENT app01 /3Z17 <br />Booth must be on <br />Concrete, Asphalt, <br />teaH Plywood, or aw