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10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />13. <br />Completed by:14. <br />Sign; <br />Health Permit <br />1 Paper Hand Towels <br />CulUnp Boon! <br />Propane Slave <br />EPropane Tank <br />FVe Extinpuliher <br />Exira lea Bags S Food Conialna^ must ba <br />stored 6 Incites off o! Uto ground/ <br />Siemo w/Chaffing <br />Dlih <br />Extra <br />(Malar <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ bleach & water tor <br />storing wiping doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAQUIN <br />C. (.)'. J N T V <br />Ice Cooler ! ; <br />jzfwater supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />L <br />Soap and Water <br />iV <br /> Paper towels and pump-style soap container. <br />Names otresponsible persons to be present in booth during all hours of opeiation. <br />I yrHz'Yv-^c---------------------—— <br />Important" <br />Bwironmenta! Health Department <br />I860 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | sjcehd.com <br />EHD 16-02 <br />07/3/17 <br />r ,, - I. ■ O' ' ■ <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 /> Ipe chests Refrigerator <br />^^Refrigerated truck C Ice bath and tubs <br /> Other (specify)__________ ___ ______________________——-------------------------------------- <br />All food vendor booths are subject to inspection. Please make a copy °' ^is_taPP'i^at'°P <br />preRfaration for this event. <br /> prwaration am <br />this^event. <br />Bleach end Waler | <br />r1 <br />Rinse Waler <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />yO Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <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 />booths <br />A copy of this checklist must be in the booth at all hours of <br />Ration. Return original to festival coordinator three weeks prior to <br /> <br />Title Date