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Environmental Health Department <br />10. <br />OR <br />12. <br />*13 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 rlnse/wastewater. <br />''Q] Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />TitleSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board a BleachPropane Stove <br />u <br />Bleach and WalerRinse Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <br />Extra Ice Bogs & Food Conlainers must bo <br />stored 6 inches off of the ground I <br />5 Gal Hand wash <br />Waste-waler Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />SanKizor budtel- <br />bloach& water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Slerno w/Chaffrg <br />Dish <br />' I <br />Soap and Water <br />0 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />O-- i 6—-2t r—ill <br />Propane Tank <br />^7 <br />Names of responsible persons to be present in booth during all hours of operation: <br />VAcky cq\\r\r> 1 <br />••Important** <br />x______________________________________ ___________ <br />_____. (X ____________________________________________________________________ _______:- <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, ... i i tA.Maron Si 90 V? <br />Date ' <br />SAN JOAQUIN <br />-----COUNTY------ <br />in-ss </ n.'-.vs here. <br />1 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 />■^0 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 />EHD 16-02 — --------- <br />07/3/17 <br />11. 11 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />10 Three compartment sink. <br />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 />Su Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution.