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S Q N J O Q U U I N Environroetiial Health Department <br /> COUNTY <br /> ;:. . <br /> 10. I 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 below417 temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice hath 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 tabtespoan of bleach per gallon of water). <br /> ❑Detergent,bleach,and wiping cloths(cleaning tcvrels). <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 oun iyle soap container. <br /> 13- Names of responsible persons to be present in booth during all hours of operation: <br /> ¢GL7 �L "20 4 'f C1L <br /> "Important" All food vendor booths are subject to inspection. Please make a copy of this apprication 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 vent. <br /> 14_ Completed by:��� Utv ltGrr2-- S <br /> Signature Title Date <br /> sza" <br /> Health Permit 11ndi"'uhV&W <br /> Sumo",1CnlrfMj <br /> P,pe'}r]n�7cvclt <br /> sn17 C55P�n:Cf <br /> G�vlrg 9c:rd sir::scrt�nc�- <br /> a:ca;n c vakr fbr <br /> Mcpane 5lb.c &ez:.1 a:nsng"�W 7 d.ft <br /> Booth must be on <br /> Ccnc;ele,Asphalt, <br /> Plywood,or a Tarp. <br /> 7mpano Tans 1I <br /> Es <br /> pay ariaA w Wise171.._t BlaehaM K4:a I Garbage <br /> at Can <br /> Frta�nvtddshn+ <br /> c , <br /> )ce C00lef � r SCSI Ny1d r.9:h <br /> E,lrro lCb B.`�SLfOaQ COn:aLlcf_ortnr Ec � y9=rc:.a1c!(:Wann <br /> 1868 E.Hazelton Avenue Stockton,California 96205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br /> FHA 1"2 Pape a of 11 TFh1P Fvp4T APP <br /> 07la117 <br />