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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />utensil wash within my <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler ! <br />Page 8 of 11 <br />Extra <br />Water <br />Soap and Water <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />SAN JOAQUIN <br />——C OU NTY <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Title <br />this event. <br />T~. <br />>e present in booth during all hours of operation: <br />J <br />ehdIos Hazelton Avenue 1 st°cl<ton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 Page 8 of 11 TEMP EVENT APP <br />□^hree co^np^rtm011^'0 k'temS W'^in bo°^for tbe san|tary cleaning of food preparation utensil <br />Names of responsible persons to b' <br />______ 4X7 <br />"Important** <br />Garbage <br />Can <br />Bleach and Water <br />[Qjce chests Q Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify)_______ ________ <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 />LJ Tub to store wiping cloths in bleach solution. <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 />and oPeration Return original to festival coordinator three weeks prior to <br /> 4/n fzi <br />Date <br />boothPr°Vidin9 the follow'n9 for adecluate hand washing facilities, but separate from <br />HWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[Zfpaper towels and pump-style soap container.