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S AN sJ OA Q U IN Environmental Health D <br /> epartment <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> F (if fcod is used the following day, maintain below 41'F temperature): <br /> ce chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ 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 /> OR ❑ Three compartment sink. <br /> tion <br /> hree deep tubs (basins 6-8 inches minimum), one for soapy water. one for ri <br /> lone tablespoon of bleach per gallon of water). using and one for a bleach <br /> etergent, bleach• and wiping cioths (cleaning towels). <br /> ub 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 /> Raper towels and Pump-style soar) container. <br /> 13. Names of ri porlsible persons to be present in booth during all hours of operation: <br /> as o�--- <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 d operation. Return on inal to festival coordinator three weeks riot to <br /> this <br /> 14. Completed by: �\ �A'C� 1�— ZZ _z <br /> ignature Title J <br /> Date <br /> Health Permit 5.2o Gal <br /> S:ernp.v;CnaKr;. Hanc wasF Na;er <br /> �'sr • <br /> Paper Hatt T�WC4 <br /> $anuzer 7ucket• <br /> °rotate Sr..Q bieaU 8 waver for <br /> 3.za;x stvnng•,"Ding Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> �roP2ne Tark <br /> Plywood, or a Tarp. <br /> Scap arc water Rinse Nater 3_ach ar^.`'ater <br /> Garbage <br /> Can <br /> c x:ra <br /> �� water <br /> Ic' e Cooler <br /> t Ell'a ice oa3s d Fcca�c^;an e's•„us17e :;astewa: <br /> 1868 E. Hazelton Avenue I Stockton California 95205 T 209 468 <br /> E+'D :6-02 342C I F 209 464-0138 www.sjgov.orglehd <br /> °age e�a�?? <br /> TEtAP EVENT APP <br />