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SA ii 1 U A U U I N Environmental Health uepavi.w,.:0'1 <br /> r •rrI " i �- - <br /> 10. 1 am orovldrne the followmo cold temperature control for the cold holding of ootenhaliy hazardous foods belc:v <br /> 45°F(if food is used the Following day.maintain below 41"F temperature)! <br /> t�lr•.e rhP.sts [I Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> 5ZOther(specify) r )t <br /> 1 I am providing the following items within my booth for the sanitary cleaning of food preparation utensil ! <br /> ❑Three compartment sink, <br /> OR ❑ 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 /> LDetergent,bleach,and vnping cloths(cleaning towels). <br /> Tub to store wiping cloths in bleach solution. i <br /> 12. 1 am providing the following for adequate hand washing faciliEies, but separate from utensil wash wan!n my <br /> booth: <br /> {Water supply dispenser with warm water at a minimum of I00`F(-e.5-20 gallon container anth spigot). <br /> 1%One separate tub(bucket or basin)for the collection of nnse wastewater. <br /> VPaper towels and pump-style soap container. _ <br /> 13. Names of responsible persons to be present in booth during all hours or operation: <br /> tovn k L Ay4 hffli <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 /> j preparation and operation. Return original to festival coordinator three weeks prior to <br /> this evem <br /> 14- Completed by: <br /> Signature Title to <br /> Health Permit kanawacnwa"M <br /> r C Slcrna w1CnnKr.9 <br /> in3 Qsn <br /> S-0 tlacrnscr <br /> xq <br /> Booth MUSI De Cn <br /> \ 3IS Yn S'+Y-Irer fn <br /> �f Frryp>u SfTr B:earn � ''o"`z9 wsvq.wry <br /> P <br /> Concrete.Asphalt. <br /> YMaooa.or a Tarp. <br /> �•�1 rrq lY.7Lnk <br /> d.1 <br /> :waA arti W-ter Wnse Wall 9:acn any W.Yer <br /> l.,lR <br /> ire E gwgrntua <br /> [Hra <br /> ,� vtnur <br /> :. �C'>?. GoO)ef � r � SC.al Ftaay npr:h <br /> r.-arw im Bo"d focay cw', ny ro Tj oe Waxen wror Cvrtar�sr <br /> Q"el G Mcde1 G Y w tw 9,G4rrtlr <br /> 1868 E. Hazellon Avenue I Stockton.California 95205 1 T 209468-34201 F 209 4 64-013 8 1 www.sicehd.com <br />