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SAN _ J 0AQU IN 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 clay, maintain below 41°F temperature).- <br /> 0 Ice chests [ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 11AM providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Lpa 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 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 during all hours of operation: <br /> **Important** All food vendor booths are subject to inspection. Please make a copy of this appli ation 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 ev <br /> 14. Completed by: a-as-Qj <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Sterno wlChaffirtg <br /> Dish <br /> Pacer Nana Towels <br /> Soap tlispenser <br /> cutting 90a c Sanmzer bucket- <br /> bleach 8 water for <br /> Pfopana Slave BlgdCh <br /> storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphatt, <br /> tiH4 Plywood•or a Tarp. <br /> Propane Tank - <br /> Soap antl water Ponse Water Bleac,"ana Water Garbage <br /> Can <br /> Fve E%[inqufaher <br /> Extra <br /> Water <br /> Ice Cooler 1 5GalHantlwasl' <br /> Extra Ice Bags 8 Food Goraawers must be Wastewater Contanor <br /> -- - -"' stored 6 inches oft of the groundr <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 F www.sigov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />