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SA N J O A Q U I N Environmental Health I <br /> COUNTY - - <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazarc <br /> 45OF (if food is used the following day, maintain below 41OF temperature): <br /> ►[ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath an tubs _ <br /> �i Other(specify} <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation <br /> ❑Three compartment sink. <br /> OR <br /> aThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and <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 utensi' <br /> booth: <br /> w =- mr Gsinr;v r,;soenser with warm water at a minimum of 1000F (i.e. 5-20 gallon container N <br /> v ; une separate tub(bucket or basin) for the collection of rinsetwastewater. <br /> 13. Names of responsible persons to be present in booth durina att pours ui ouc:e;t:tvrt: <br /> — �. <br /> vencor nocths are sub;ect to insocc icn. Please make a corn I, of l <br /> 14. Completed by: <br /> Signature Title Da- <br /> r' 'r 5-2D Gal. <br /> Health Permit Hand wash Water <br /> Stoma w1ChaKng <br /> Dish <br /> Soap dispenser <br /> Cutbnq Board <br /> Propane Stave Slaach <br /> b 0 'Z" <br /> Propane Tank <br /> Soap and Water Rinse Water fand Garbc <br /> Cat <br /> roo FAnquisher <br /> 6dra <br /> Water <br /> Ice Cooler I 5 Gal Han <br />