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Environmental Health Department <br />10. <br />45°J <br />11. <br />OR <br />Thn <br />12.utensil wash within my <br />W; <br />Paper towels and pump-style soap container. <br />13.be present in booth during all hours of operation: <br />14.aCompleted by: <br />Signature Title <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />u <br />Soap and Water Rinse Water <br />Fire ExtinguisherCH <br />Ice Cooler <br />Garbage <br />Can <br />supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />Names of responsible persons <br />‘‘Important** <br />“ I <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />—---------------------/ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />LJ Three compartment sink. <br />eh8d?bop Hazelton Avenue I Stockton, California 95205 | T 209 468-3420, F 209 464-0138 | www.sjcehd.com <br />07/3/17 Pa9e 8 °f 11 TEMP EVENT APR <br />boothth® following for adequate hand washing facilities, but separate from <br />Propane Tank <br />--------------------—JI <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, , _ ----------------------------K--------- <br />H - 2 «X) <br />Date <br />SAN JOAQUIN <br />------COUNTY------- <br />.>.• Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />food is used the following day, maintain below 41 °F temperature): <br />SJce chests Q Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) <br />-■ <br />I <br />| Health Permit t <br />S.SS'Soki'i133 (basi?t 6'8Jnches minimum), one for soapy water, one for rinsing and one for a bleach <br />soltrtiop^one tablespoon of bleach per gallon of water). <br /> p^tergent, bleach, and wiping cloths (cleaning towels). <br />LZlTub to store wiping cloths in bleach solution.