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Environmental Health Department <br />10. <br />J <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100‘ f- (i.e. 6-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container, <br />13.N. <br />“Important** <br />Completed by;14. <br />XHealth Permit <br />PajMsr HWl 'oweis <br />Bleach <br />J <br />Pwaw Tank <br />W(5?C? <br />ftf'e 1 <br />SAN JOAQUIN <br />t«Mj Waj«< <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O Three compartment sink. <br />Cfcfra tee iiaits & f udd rtVfSf <br />srarM? fi j oA' of ihr <br />Stem# <br />Jj Gal Hmt? wav's <br />Garbage <br />Can <br />Sarwtaer <br />S for <br />Stonttg wpavj cloths <br />Booth must be on <br />Cortcfete. Asphalt. <br />Plywood, or a Tarp. <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <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 below4IT temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />Pl Other (specifyL^ . <br />t:xUa <br />WaW <br />U.A>vViz>Zi <br />Signature <br />to - <br />Date <br />Al! food vendor booths are subject to inspection. Ptease 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 />BQLZ <br />Rinse Wstet <br />1868 t Hazelton Avenue I Stockton California 95205 | T 209 468-3420 | F 209 464-0138 | www.Sjgov.org/chd <br />EHB 1M2 Pi»9« 8 o? 15 TEMP KVt'NT APR <br />oarisns <br /> <br />Title <br />lames of responsible persons to be present in booth during all hours of operation: <br />................. ............ ......... ..... ............. <br />I Ice Cooler <br />Sri»o 1