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SAN JOAQUIN Environmental Health Department <br />10 <br />11. <br />OR <br />soapy water, one for rinsing and one for a bleach <br />12. <br />adequate hand washing facilities,but separate from <br />14 Completed by: <br />Title Date <br />i Health Permit <br />Sleriw w/CJwifftiKj I <br />L__22L.__J <br />• '•ttitv Hariri Inwri,..Soap dispenser <br />Cultinq Hri.tr, l 1I Stow <br />Bln.icti <br />T <br />Rinito Water Bltrach and Wator <br />Pirc Cictiritjuislwr <br />Ice Cooler <br />F 209 J64-0 : <br />Garbage <br />Can <br />Bonih inusi ho m> <br />Concrete. Asphalt. <br />Plywood, or a I arp <br />f Hazelton Avenue <br />Ll-ID 1f> a/ <br />07 Gt <br />k » Hugs ,t P<xxi CnmiHnets must <br />■•im't! fi uK htv. olt m ihn nmuntl' <br />5 Gai Hand wnsh <br />Wastowatw Conttunnr <br />ft ?l) Gal <br />Hann wash W.it<v <br />Sanitizer Liitc itui <br />I'le.t, p n watfn f,„ <br />■lonng wiping r.ipip^ <br />Stockton. California 95205 | T 209 468-3420 | <br />Page R of 11 <br />all hours of operation. <br />P f’lrip.inr, rank <br />__J. <br />Soap and Watrn <br />A copy ol this checklist <br />Return original lo festival coordinator three <br />>ignatare <br />— "■ - ‘-<PP-.ai.on ,n <br />tHsZent OP^/1^/~^!i'^^^~^4estival^orelin1ator thre^w^ks X to <br />www •ign1,' <br />TFMP EVENT r.pp <br />utensil wash within my <br />ywatersupply dispenser vrith warm water at a minimum ol WOT (i.e. 5-20 gaiion container with spigot). <br />[^Oneseparate tub (bucket or basin) for the collection of rinse/waslewater. <br />Shaper towels and pi|mr style soap container. <br />13 *° / bo°ih during <br />“Important** <br />[^0^ 6 USed ™int “ntoow 7it tempe'ra'ure)0' pO,**n‘ia"V foods below <br />. " • Refrigerator <br />J Refrigerated truck q lce bafh and (ubs <br />L I Other (specify) <br />I am providing the following for <br />booth <br />□ Three compadment's'ink "emS W"h'n my b0°,h '°r lhe san',ary <^"'"9 of food preparation utensil <br />f-.ktra <br />W.-rtf-r