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Environmental Health Department <br />-TO. <br />11. <br />OR <br />12. <br />i <br /> Water supply 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 rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />■DateSignature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />41 Bleach and Water7 <br />Fie Extinguisher <br />Fxka <br />Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 GaL <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping dnlhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 O Refrigerator <br />O Refrigerated truck Ice bath and tubs <br />O Other (specify) __________________________________________________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink. <br />Stcmo w/Ghaffing <br />Dish <br />5 GaJ Hand wash <br />Wastewater Container <br />LJ 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 />1 <br />■— <br />SAN JOAQUIN <br />— COUN'TY— <br />Health Permit <br />■ <br />"Important** <br />Rinse Water <br />Exira ice Bags & Food CorGainats must be <br />stared 6 indies off of the ground! <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />______ <br />i Ice Cooler <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 event ■ u -mm <br />March 2022 <br />Title <br />4 <br />, 1—11 f22 <br />7 <br />Soap and Water <br />1868 E. Hazelton Avenue [ Stockton, California 95205 ] T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEM3 EVENT APP <br />07/3/17