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documentsclfipti0z00033a6iwcb8g9ho.jpg 1,355x1,8"' nixels 5/8/23, 2:15 PM <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />fe separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Completed by: / J14. <br />Health Permit <br />Paper Hand Towels <br />Culling Board <br />Propane Stove <br />n <br /> <br />i <br />Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />https://eventlocker.s3. amazonaws.com/events/62c5fd6491bda700127ae.../6419dfbdf23d8c0019f88f59/documentsclf ipti0z00033a6iwcb8g9ho.jpg Page 1 of 1 <br />5 <br />Date <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />San.tuor bucket­ <br />bleach & water for <br />storing wtp.ng cloths <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tag <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[Sfwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />5-20 Cal. <br />Hand wash Water <br />{ <br />SAN JOAQUIN <br />------COUNTY <br />' Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45I,F (if food is used the following day, maintain below 41 °F temperature): <br />^[^Tlce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ________________________________ <br />C0-0-V <br />Title <br />_Z <br />Rinse Water <br />1 • • •• -...........-—■—11 <br />Extra /ce Sags & Food Containers must be <br />stored 6 inches off of tho ground' £1 <br />I Bleach <br />I am 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />| Propane TanK <br />’ 7 <br />I Soapdspcnsor <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwv/.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19/19 <br />Names of responsible persons to be presentin booth during all hours of operation: <br /> <br /> <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 />thisrevent. i , <br />Signature <br />Extra <br />Water