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Environmental Health Department <br />10. <br />11. <br />1 <br />OR <br />12. <br />N;13. <br />14.Title <br />Health Permit Paper Hand Towels1 <br />JCulling Board <br />Bleach <br />Propane Stove <br />Bleach and WalerSoap and Waler <br />Fire Extinpoiaher <br />JIce Cooler <br />209 468-3420 1 F 209 464-0138 I www.sJcahd.cOTn <br />TEMP EVENT APP <br />rgSara <br />5-20 GaL <br />Hand wash Waler <br />Garbage <br />Can <br />Slarno w/Chafflog <br />O:sh <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />____ <br />Rinse Water <br />Water <br />Ihi&flvenL^ <br />Complete^byT^lld^^f:^— <br />(ignature <br />Propane Tank <br />?•. : <br />rf responsible persons to t <br />"Important** <br />Soap dispenser | <br />Exira fce Bags & Food Containers must <br />tlorad 6 Inches off of the ground! <br />'4'^ vendor booths are subject to tnspecfon. Please make a copy of <br />Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T <br />EHD 16-02 <br />07/3/17 <br />SAN JOAOUIN <br />-----COUNTY------ <br />I am providing'frie 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 $Refngerator <br />Q Refrigerated truck O lce bath and tubs <br />Other (specify) --------------- ----- ---------------------------;-------------- - <br />lam providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />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 />booth: <br />Water supply dispenser with warm water at a minimum of lOtfF (l.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />tie persons to be present in booth during all hours of operation: