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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 />O One separate tub (bucket or basin) for the coftecfion d! rinsefwastewater. <br />SPapertowels and pump-styla soap container. <br />13. <br />March 5 202514.Completed by: <br />Signature <br />Health Permit <br />Paper HarnTTowote <br />Propane ^Stove <br />IceCocder 1 <br />Wastewater Container <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth- <br />Stemo w/Chafftnfl <br />Orth <br />Saniiizar bucket- <br />bleach & waler for <br />storing wiping cloths <br />Title <br />Gaibajje <br />Can <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sokrtorrtone tafejespoorr of bleach per gallon of water). <br /> Detergent bfeacfi, and wiping cloihs(daaning towels). <br />O Tub to. store wiping cloths in bleach-sok^ion <br />■....................................... .. <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tatp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />(\xX\fe€S \wmracK OhA <br />“trnportsmt?* Ait food AendoZ bboths are subject to inspection. Please make a cof^ 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 oDeratiori.-^tum ortgktai to fijstival coordlhatof prior to <br />— C O U NT Y— <br />Grea! ness grows here. <br />pvldihg the following cold temperature control for the cold holding of potentially hazardous foods below <br />(if food is used the following day, maintain below 41OF temperature): <br />0 Ice chests Refrigerator <br />Q Refrigerated truck 3^eebato 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 PageB<rf11 TEMP EVENT APR <br />07/3/17 <br />IP- I am pn <br />459FI <br />1 <br />Date <br />£ ttanUiMMcrefStenma! fl <br />( CuangSoorU <br />Bleach <br />and Water <br />Extra <br />Water