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Environmental Health Department <br />10 <br />11.I ai <br />OR <br />12. <br />Water suppl/ 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 nnse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />jnature <br />§ <br />]Paper Hana Towels <br />Soap dispenser <br />BleachPropane Stove <br />Soap and Water Bleach and Waler <br />Fire Extinguisher <br />0 <br />Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />j^providmg the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink <br />All food vendor <br />preparation for <br />preparation anc <br />this event. <br />Sterno w/Chaffrng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <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 />5-20 Gal <br />Hand wash Water <br />Date <br />Health Permit <br />SAN JOAQUIN <br />COUNTY <br />fixtra fee Sags & Fooa Containers must be <br />I tored 6 inches off of the ground' <br />Title <br />ths are subject to inspection. Please make a copy of this application in <br />event. A copy of this checklist must be in the booth at all hours of <br />7 <br />**lmportant** <br />Names of responsible persons to be present in bgpth during all hours of operation: <br />booth! <br />this e' <br />oceration Return original to festival coordinator three weeks prior to <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4IC£ (if food is used the following daymnaintam below 4VF temperature): <br />chests ^JCfRefrigerator <br /> Refrigerated truck Ice bath and tubs : <br /> Other (specify) <br />Propane Tank <br />------------------------------j <br />-------rq <br />Ice Cooler <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 3 of 11 TEMP EVENT APP <br />07/1/17 <br />'£2zZfhree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />soMion (one tablespoon of bleach per gallon of water). <br />JDetergent, bleach, and wiping cloths (cleaning towels). <br />^|Tub to store wiping cloths in bleach solution. <br />Cutting Board