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Environmental Health Department <br />10. <br />11. <br />OR <br />12.my <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 galli <br />O Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Title <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />J <br />Ice Cooler <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />J 01 <br />Stemo w/Chaffing. <br />Dish <br />Ion container with spigot). <br />Propane Tank ------------------------1 <br />irowmiiiiiiHMMim <br />| Health Permit | <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sicehd.com <br />n-m/176’02 Pa9e 8 of 11 TEMP EVENT APP <br />V / I'JI I f <br />3.Jr i <br />Soap and Water <br />n <br />D <br />Rinse Water <br />fne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness jrorvs heie. <br />1 a^o£r?yLdin9 the followin9 cold temperature control for the cold holding of potentially hazardous foods below <br />^5F,(if food is used the following day, maintain below 41 °F temperature): <br />J3dce chests Q Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) <br />□^hre Vld'n9 foll°twiri9 items within my booth for thG sanitary cleaning of food preparation utensil <br />ThreG deeP tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sotuiiofr(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 />— <br />—jl I <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />Extra Ice Bags & Food Containers must be B <br />stored 6 inches off of the ground! <br />“Important** J\ll r^d vendor bloths are subTect to Inspection. Please make a copy of this appllcat^Tin <br />preparation for this event. A gopy/Cf thja; checklist must be in the booth at all hours of <br />preparation and Rqfuri/pr^Kfal to festival coordinator three weeks prior to <br />L’->.