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Environmental Health Department <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />jQ One separate tub (bucket or basin) Tor the cotlecfion of rinse/wastawater. <br />JPapertowefe and pump-style soap container. <br />13. <br />14.Completed by: <br />Date <br />Paper HarKTTowBis <br />I am providing the foltowing items within my booth for the sanitary cleaning of food preparation utensii <br />Q Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Siemo WChafftnfl <br />Dish <br />WO Gal. <br />Band wash Wister <br />Sanitizer buokel- <br />bteach & water for <br />storing wiping cloths <br />7 IceOoder <br />Propane ^Stove <br />............. i ...... d <br />pvidirg the following cold temperature control for the cold holding of potentially hazardous foods below <br />(if food is used foe following day, maintain below 41 °F temperature): <br />0 Ice chests Refrigerator <br />Q Refrigerated truck Ql^bafo and tubs <br /> Other (spectfy)___________________________________________________________ <br />um orilgnaF to tegtfvafcoordlMtof ftme weefcs prior to <br />3/27/2021 <br />TM« <br />Names of responsible persons to be present in booth during all hours of operation: <br />**tmportsrrt^* <br />1868 E. Hazelton Avenue | Stockton, California 95205 ] T 209 468-3420] F 209 464-0138 ] www.sjcehd.com <br />EHD 16-02 Page BoT 11 TEMP EVENT APP <br />07/3/17 <br />SGai Handwash <br />Wirtawator Container i <br />Gartwge. <br />Can <br />____Cfd TQXtU- ’______________________ <br />firVifiSci _____________________________ <br />Alt food vendor bboths are suttee: to inspection. Please make a co?^ of this application in <br />preparation for this event. A copy of this checklist must be in the booth at alt hours of <br />preparationanddperation^ — <br />this event. /a <br />' . Ms' <br />v Signature <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 />fj Detergent, bfeecfv and. wiping cloths (daarwg towels). <br />LJ tub to. store wiping cloths in bleach- sofottoa <br />r -x <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />* Health Permit <br />1 J Btti»jc»»w»aE»aJCiiiWiiii «mats* J <br />1 VtnUSMAraorcrthegraMf W <br />[ CuOiWBoart <br />SANJOAQaiH <br />—COUNTY— <br />Greal-ness grows. ..here. <br />lam <br />4! <br />Bleach <br />ffleach and Water