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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />iresent in booth during all hours of operation:13. <br />Completed by:14. <br />Health Permit <br />Paper Hand Towels <br />Soap dspenser <br />CuUlng Bca-d <br />BleachPropane Stove <br />I <br />Prepare Tank <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APR <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Stemow/Chatfng <br />Dish <br />Sanitizer bucket- <br />bieach i waler for <br />stortr.g wlpitg c*0"11'3 <br />Soap and Water <br />■"Important** <br />iu_Z <br />Rinse Water <br />Extra Ice Bags & f ood Containers must be f. <br />stored 6 Inches oflotlhe ground! <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />I tMr I .Vi.Im I <br />EHD 16-02 <br />07/3/17 <br />SAN JOAQUIN <br />!' ------COUNTY------- <br />l;, G; frll IIP-. ■. f/iOlV1; I <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 E Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).---------------------- ----------------------------------------------------------------------------------------------- ------ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />H 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 /> 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 />boopi: <br /> Water supply dispenser with warm water at a minimum of 100*’F (i.e. 5-20 gallon container with spigot). <br />Names of responsible persons to be-jiresent in booth during all hours of operation: <br />□■GjcZ --------------------------------------------------- <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 even^/0 5-?^^ <br />Date <br />Exira <br />Waler