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SAN 10AQUIN Environmental Health Department <br /> - COUNTY-- <br /> 10. 1 am providing the following 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) NIA <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. NA <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). NA <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 pump-style soak container. NA <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Nico'e 00oa <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 a eratio Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14- Completed by: owner 9110,r2025 <br /> Signature Title Date <br /> r— <br /> s•zo gal. <br /> Health Permit Hana v.a h Lva:er <br /> Slema wYJuCinp <br /> fish <br /> PaP•r Pane Tm:e1s <br /> SaaP dspenslr <br /> Cooling 9oard <br /> Saniiizar nvuct- <br /> hlcach L ureter for <br /> PrnPane Slm:e Bleach scaring vriping rJax <br /> Boolh must be on <br /> 0 Concrete,/tspnall, <br /> i'lywood.or Tarp. <br /> Prcpaae Tark <br /> Soap and water Rinse wafer aiearh and Walor Garbage <br /> Can <br /> Fire Eaingd.her <br /> Erlra <br /> Vlaer <br /> Ice Cooler / f--— �� — 5Cal Fir dr ash <br /> Fxtra ice Sags d Food Conlalners must be Vaste:vaper Container <br /> slored S Inches off orfhe ground! <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 T 209 468-3420 F 209 464-0138 www.sjcehd.com <br /> EHD 16-02 Page a of 11 TEMP EVENT APP <br /> 07l5117 <br />