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SA NUJ OAQ U IN Environmental Health Department <br /> V`. UN -r '- <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 /> E ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck 21ce 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 /> ['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 rinseiwastewater. <br /> E5 Paper towels and um -st le soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> PAC HFP <br /> *'Important** All food vendor booths are subject to inspection, Please make a co <br /> PY of preparation for this event. A cop f this checklist must be in the booth iata all lihours of <br /> preparation a d operation. al to festival coordinator three weeks rior to <br /> this e <br /> 14. Completed by: M�}Nr9G�,� a3 a5 <br /> Sig Title <br /> Date <br /> Health Permit &20 Gal <br /> S?errp wlChar(r^_ <br /> Hann wash waier <br /> D,sr <br /> Page!Mang Tpyrels <br /> samtrZer buake:- <br /> Prppane S?ove Bleach breach a wa?er rot <br /> sionng wpmg rims <br /> Booth must be on <br /> Concrete,Asphalt. <br /> b' Plywood,or a Tarp. <br /> Pr7Pare Tar: - - - <br /> ! Scaa ark:^.a:er R,r <br /> se water 3ieach art:aa;er <br /> Garbage <br /> Fire Extinguisher Can <br /> Enra <br /> uVatsr <br /> Ice Cooler ! ! r �r .�: :- -• :s ,.� <br /> 5 uai HanC_:a5!' <br /> 1868 E. Hazelton Avenue ) Stockton. California 95205 1 T 209 468-3420 <br /> =HO 16-02 F 209 464-013$ I www.sjgov.org/ehd <br /> -----^- Page B of 11 <br /> TEMP EVEN'APP <br />