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5A N J OAQ U I N Environmental Health Department <br /> —COU NTY <br /> 10, 1 am providing the fallowing cold temperature control for the cold holding of potentially 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) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <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 /> 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 rinse/wastewater. <br /> ❑Paper towels and sump-style soap container_ <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> rianne D nicr <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 oriciinal to festival coordinator three weeks prior to <br /> this event/ Own. 04/1 SIL <br /> 14. Completed by: <br /> Ignature Title Date <br /> � 5-20 Gal. <br /> Health Permit Ha d u dsh Water <br /> slefM w/Chatfing <br /> rnsrl <br /> Papet Hand Towels <br /> Suaptlispenser <br /> Ctatiag � Soniraer bucket <br /> ateach d water far <br /> Propane Slote Bleach slodng wiping elolhc <br /> Booth must be on <br /> _ Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Scrap and Water Rinse Water Bleach and Wafer Garbage <br /> Fite ExUngulsher I Can <br /> Ex7a <br /> Wafer <br /> Ice Cooler 5Gs1 Handwash <br /> &hake Bags&Food Conlainara musl be wastewater CPnlaincr <br /> srorad$[Aches oNorthe prauldl <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 j T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> END 16-02 Page a or 11 TEMP EVENT APP <br /> 07f3l17 <br />