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SAN JOAQUIN 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 /> p!l ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. I 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 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 /> ❑Water supply dispenserwith warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> [X One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ❑ Paper towels and pump-style soap container. <br /> 13, Names of responsible persons to be present in booth during all hours of operation: <br /> Bernard Martinez Monica Archuleta <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 and operation. _Return original to festival coordinator three weeks prior to <br /> this event/�� <br /> 14. Completed by: d + J Manager 412212025 <br /> Signa ure Title Bate <br /> r- - ---- <br /> 5-20 Gal. <br /> Health Permit Hand wash waver <br /> 5u:mo en'ChaHing <br /> Dish Paper Hand T—e[s <br /> Soap d�apcnser <br /> C�[unq Boa[tl sireizer bucket, <br /> Ueech L waler far <br /> Propane Stove Bleach s:crinq wOrg dolhs <br /> Booth must be on <br /> O Concrete.Alpha€l, <br /> Plywood,cr a Tarp. <br /> Propane Tangy <br /> Soap and Wxer Rinse water Beach and SNalu Garbage <br /> Fro Exlinganwr Can <br /> E�rE-i <br /> V�b:er <br /> T ice Cooler <br /> E+Na Ice Bags d Food scrodContainers m�sl Oe J Peas:nwlcr eanlalncr <br /> ------- 6 inches on a the gmund! <br /> 1868 E. Hazelton Avenue] Stockton,California 95205 1 T 209 468-3420] F 209 464-0138 1 www.sjcehd.com <br /> EHo 16-02 Page Bof 11 TEMP EVENT APP <br /> oy13l17 <br />