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S A N J O A Q U I N Environmental Health Department <br /> —COUNTY— <br /> . <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(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 incltes 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 /> 2</�' ater supply dispenserwith warm water at a minimum of 100eF(i.e.5-20 gallon container with spigot). <br /> 9-6ne separate tub(bucket or basin)for the collection of rinselwastewater. <br /> [gaper towels and pump-style soap container. <br /> 13. NN�t C:s of responsibie persons to be present in booth during all hours of operation: <br /> +� -��� _1 Irn e s 56 fit...—F Vte-y _ <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 ail hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> th' event. <br /> 14. Completed by:( irtnlYu/l 1 3 j <br /> Signature Title Qate <br /> r --- <br /> 5-T0 Gsl. <br /> Health Permit Handy sh Waler <br /> Ste rna rNChaYmg <br /> Guh <br /> Payer Hand Tw+ep <br /> Sax➢GisPr>s:er <br /> Culling Board Sanulurhtt:kel- <br /> Wcefi L:ro[er for <br /> ?roPane Stcve �eadr staring Aping cMdw <br /> Booth must be on <br /> - O Concrete.Asphalt, <br /> Plywood, <br /> or a Tarp. <br /> Acpae7enk <br /> Soap and Water R We Wamr Bit end VJa'u Garbage <br /> Can <br /> F'ua"ingWshar <br /> Eadra <br /> WaStt <br /> ICE Cooler t--_.- - . - s Gal Hml,am <br /> Exft he Begs Food Containers rmw be LWstniater ConL-lnor <br /> -- --- sfared6lrchps Woftho9rauod7 <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 I T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EH❑18.02 page S of 11 TEMP EVENT APP <br /> 071W17 <br />