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Environmental Health Department <br /> <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Signature Title Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 1Propane Stove Bleach <br />Propane Tank 1U1 Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />_z <br />Soap and Water <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br /> Water supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot) <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />O' Paper towels and pump-style soap container. <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />( Extra \ <br />Water <br />j i h <br />"Important** <br />Health Permit <br />fhoHazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />07/Sl7 Pa9e80,11 TEMPEVENTAPP <br />■■■■■■■■■■■■■■I <br />Extra Ice Bags & Food Containers must be 1 | <br />stored 6 inches off of the ground! <br />^31 I <br />Names of resppnsibll^persorisjo be present in booth during all hours of operation: <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. --------- <br />SAN JOAQUIN <br />------COUNTY <br />Gre ows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: ’ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I I Three compartment sink. <br />H^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.