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rL41r: sAN� oAQuiN p <br /> - Environmental Health Department <br /> COUNTY <br /> v`�?-�r urrat�ESS gr,�ws i,r.2 <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 /> chests Refrigerator . <br /> ❑ Refrigerated truck ❑ ice bath and tubs <br /> ❑ Other(specify) <br /> 11. € 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 /> solqtierr(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 /> ater supply dispenser with warm water at a minimum of 100°F (Le. 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. NarUe of responsible01-"f <br /> per to be present in booth during all hours of operation: <br /> �cx ?v <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 fesXival coordinator three weeks prior to <br /> this ent. r <br /> 14. Completed by: 6-�� -- ��t-L C ZA, �� <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash water <br /> Slerno wiChaf rg <br /> Dish <br /> Paper Hand Towels <br /> Soap disnenser <br /> Cumn,Board Sanozer bucket. ^ <br /> bleach&water for <br /> Prapana Stow Bleach sionng wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> - Plywood.or a Tarp. <br /> _r 7 rf a <br /> Propane TdnA - - .• - - — - <br /> So ary Wale, R,nSe writer Bleach ano water <br /> Garbage <br /> Can <br /> Fire Eztrn.10shor <br /> � E>tSra <br /> water <br /> ,i <br /> Ice Cooler 5 Gal Hand wash <br /> EA1,a Ice Sags&Foed Conrairvs rust be wastewa[er Container <br /> stored 6 mches orrof rrre ground) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> Pone A nr 11 TEMP EVENT APP <br />