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Coldra Surd 1 <br />P•opand Sdowr <br />i <br />loe Cooler <br />ar.d, drvd WNW <br />r• I WIGAIJ.111 <br />nor lira wall <br />riadid4orldo foraadrao adtdp,. 8444 Food Cu/tondo; be <br />Ilwrd d exto• I :Bath* trunk!' <br />Soso 41444.6.11, <br />Fag. 4 i01,43 <br />[ <br />4.40. 4 we. ... <br />svev, 44,,,4 <br />Boom must be on <br />Concrete Aspears <br />Plywood Or a T :vp <br />Garbage <br />Can <br />1 Heaft".1117171711 %On. erk.N101,-.4 <br />IAN <br />s 20 ara I <br />PiAnd ...kWh Wry <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />10 I am providing the following cold temperature control for the cold holding of potentially hazardous froth bete)* <br />4.5"F: (if food is used the following day, maintain below 41T temperature) <br />( 1 Ice chests Li Refrigerator <br />ri Refrigerated truck H Ice bath and tubs <br />Li Other (specify)._ <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />U Three compartment sink <br />Throe 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 />Ej Detergent, bleach, and wiping cloths (cleaning towels) <br />LI 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 />Water supply dispenser with warm water at a minimum of 100T (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 />13 Names of responsible persons to be present in booth dunng all hours of operation: <br />14.-3—FLAN T1./J&JA- <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 />this event. <br />14. Completed by Pi 1•3 N k UnNie- jL 0 u?.12 <br />Signature Title Date <br />I !, 4;trettn't Avontro j Stockton, California 95205 I T 209 468.3420 I F 209 464•0138 1 www sigov org/ohd <br />1.. e0 Pejo I3 <br />OR