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Environmental Health Department <br />10. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />DateTitleSignature <br />Health Permit <br />!Papor Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Slow <br />Propane Tank <br />Rinse Water <br />Fira Extinguisherfl <br />_____________________■ •_______________________________ <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Stemo w/Chatfing <br />Dish <br />Extra <br />Water <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 />-------COUNTY—- <br />Greatness grows here. <br />J <br />Soap and Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />------------ --------- <br />Akf/ i / ______ ___________________________ ______________________— <br />"Important** 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 <br />Ice Cooler <br />_Extra /ce Bags & Food Containers must be R <br />stored 6 inches off of the ground! | <br />..vv, <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 41T temperature): <br />EQ Ice chests E3 Refrigerator <br />Q Refrigerated truck O Ice bath and tubs <br /> Other (specify)__ _ __________________________ <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />(3 Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 TEMP EVENT APR <br />07/3/17 <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />(2*Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot).