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SA N J OA Q U I N Environmental Health Department <br /> — COui.ITY- <br /> 10. 1 am providing the following cold temperature control for the cold holding of patentiafly hazardous foods below <br /> 45'F(if food is used the following day, maintain below 41'F temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) Nla for us <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> 4R <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(6eaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12• 1 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 100'F (i.e.5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinselwastewater. <br /> Paper towels and um -st le sea container. <br /> 13, Names of responsible persons to be present in booth during all hours of operation: <br /> layna Casey,_ Bret Casey <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 eve <br /> 14- Completed by: Owner 716125 <br /> Signature Title Date <br /> Health Permit Hard rash 6vater <br /> Stems vrlChatfmg <br /> Gish <br /> Parer HaM Ttnvds <br /> Sozp d�:penaer <br /> Culling itaani Sarti',izer bsxhet- <br /> =h•wa•.or'or <br /> Propane Stove Bleach stddng vXping doths <br /> Booth must on <br /> � Goncrele,Aspp halt, <br /> 0 Plywood•or a Tarp- <br /> Prc7a�e Tnnl� 111 <br /> Soap and u'aier Rk�sa Willer Bleach ar,�L+:a;r. 1 <br /> rl Garbage <br /> Can <br /> _ Fie Extinguisher <br /> EWd <br /> Watc: <br /> Ice Cooler � Hard wash, E1lra Ke gags S Food ccwlonrrs-'sr he 'h'as:trvater Container <br /> slorel 6 urJres orr or[no 17munx' <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> FH€)15-02 Page a or 11 TEMP EVENT APP <br /> 0713117 <br />