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S A N J a A Q U I N Environmental Health Department <br /> ---C CCU NTY-- <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 9r F (if food is used the following maintain below 417 temperature): <br /> �i{Ice 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 /> ❑ 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 /> soon (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 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 pump-style soap container. <br /> 13. Names of responsible persons to be present in booth durin all hours f operation: <br /> �)e,t4-4 ScZ� no I �i q _::� - Z�y 1' � <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 flours of <br /> preparation and o ration. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: <br /> Signature Title Dat <br /> , car <br /> 5-20 Gal. <br /> Health Permit Hand wash water <br /> Stemo wlchaf irl <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> cuning Board S. -i r bucket- <br /> 7\ — <br /> bleadt .water for <br /> Propane Stove Bleach storing wiping Goths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane TanF - <br /> � aa and water Rirse Water Bleach and water Garbage <br /> Can <br /> at Fire Exunpuisner <br /> Extra <br /> water <br /> i� C'--T; 6'0_ <br /> oler �" "`+t"!'::'. 5GMHandwasl <br /> Eartra ice Bags&'rood Centarners mus!be .`i vvastewater Cantwner <br /> stored 6 inches off df Iha ground, j <br /> 1868 E. Hazelton Avenue i StocKton. California 95205 ( T 209 468-3420 I F 209 464-0138 1 www.sjgov.org/ehd <br /> ENO 1od12 Page B of 11 TEMP EVENT APP <br /> nc'1)nnn�o <br />