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SAN JOAQUIN Erivii'onrnental Health Department <br />10. <br />12. <br />IJkP'dper towels and pump-style soap container. <br />13.Names of r< <br />I <br />Completed by: 14. <br />Health Permit <br />Culling Hoard 1I’ropaiw Slovc <br />I <br />Soap nndWolcr <br />]Fira Fxlnifiulshcr <br />Ice Cooler <br />f <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 dayjnaintaln below41T temperature): <br /> Ice chests Snefrigcrator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />rura Ice linns & Food Conlaincts must bo <br />Mrcd 0 IikIios oilo!tno ground' <br />Slnrrio v/lCliariinnDisb <br />6 Gal Hand vrajli <br />Wo$t water Container <br />Garbage <br />Can <br />Saniltar bucket- <br />bleach & water lor <br />storing vriplno cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />to be present in booth during alLhours operation: <br /> <br />Title <br />S-20 Gol <br />I fond wash Waler <br />^ponsiblo perj <br />J Pleach and Water <br />T <br />lihise Waler <br /> <br />**lmpo riant** <br />Propane Tank <br />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 eyqnt, <br /> <br />Date <br />11. I anwroviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />IRThree compartment sink. <br />OR <br />SigimiiTfjX <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 />[J Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />f’^TVVater supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />L^^fno separate tub (bucket or basin) for the collection of rinsc/wastewater. <br />[ Sonp iliapcn.ier | ____ <br />18(58 1: I lazc’lion Avenue I Stockton. California 95205 | T 209 468-3420 | l: 209 464-0133 | www.sjgov.oig/ohd <br />EHO 16 02 Page 8 of 11 THMP EVENT APP <br />07/01/202-1 <br />I Biondi