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N -JDAQU Environmental Health Department <br /> C o u N T Y-- <br /> '�,+a•�:,ti''' C�te�I'ne55 yr�tvs ?tc:r•r. <br /> 10. I dm providing the fotlovwing cold temperature control#br the cold holding of potentially hazardous foods below <br /> 45'F(if food is used the foffowing day,maintain Below 41°F temperature): <br /> ❑ ice chests fl Refrigerator <br /> ❑Refrigerated truck El 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 camparlment sink. <br /> OR <br /> 0 Three veep tubs (basins G-8 inches minimum), ene for soapy water, one for rinsing and one for a bleach <br /> sa ion{bne tablespoon of bleach per'gallon of water). <br /> Detergent,bleach,and wiping cloths(cleaning towais). <br /> Tub to store wiping dloths in bleat;tl'solutiori. <br /> 12. l am providing the fallowing for adequate hand -crashing facilities, but separate from utensil wash within my <br /> booth, <br /> El Water supply dispenser withi Wprm water at a mrnirnuM of 1 QOaF(Le.5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the callection of rinseMastewater. <br /> r <br /> ❑Paper towels and pump.-style soap corMiner, <br /> 13. lrlaM6s of responsible persons to be present In booth during all hours of operation. <br /> D <br /> **Important'* Ail food vendor booths are subject to:inspe~c0on. Please make a c5py of this application in <br /> pr ratio ' far this event. A ebpy of this checklist must be in the booth at. a1I hours of <br /> p paratib nd ap ration. Return original to festival coordinator three.weeks prior to <br /> th s event; <br /> 14. Completed b' 4N, W <br /> Sign.afiure Title Rafe �1 V <br /> E ., 6-2tl sal. r�6 _F <br /> Health Permit HenawasnlNelet <br /> SleinaWlCliatfinp <br /> f)k� <br /> Paper,�ar:d 7awelc <br /> Swap dspenser <br /> CuHiAg 8aartl i Sanilrzerhvckel- <br /> bleach&v+alartar <br /> Prapsn9 Slave slorfng vripinO dolhs <br /> Booth must be pn <br /> Concrete,Asphalt, <br /> Prywood,or a Tarp. <br /> SaepandWaler RinseWaEar &#eachandwaler Garbage <br /> Can <br /> Fire Extinguisher <br /> 1]�1fza <br /> Waler <br /> 1C� C1701er `�'�iP-"r �' 5GalHandwash <br /> atra Ice 8ags6FoodCan'l101110smuslba WmIeweiercenlalner <br /> Slo 36inchesolroflhegraundl 'E <br /> 1868 E.Hazelton Avenue J Stockton, California 952-051 T 209 468-34201 F 209 464-0138 1 www-sjcehd-com <br /> EHO 10.02 Page e of ii TEMP EVENTAPP <br /> o7r31-17 <br />