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SANJ0AQUIN <br /> -�- Environmental Health Department <br /> w't}" C CCU NTY <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 /> 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 /> solution (one tablespoon of bleach per gallon of water). <br /> K 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 /> hA-ToU'_k 200 _ 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 hours of <br /> preparation and operation. Return original to fes iyal coordinator three weeks Prior to <br /> this ev alb 1a� S. <br /> 14. Completed by: <br /> Signa ure Title Date <br /> 5-20 Gal <br /> Hand wash Water <br /> Health Permit <br /> Slema w/Chaffl ng <br /> Dish Paper Hand Towels <br /> Soap tlispenser <br /> Cutting Board Saniuzer bucSre:- <br /> Weach 5 waler for <br /> $leach storing wlprng cloths <br /> Propane Stove <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tark — - -" "` <br /> Soap and Water Rinse Water Bleach and Tatar Garbage <br /> Can <br /> Fire EatinQursher <br /> .�..: t <br /> 't water <br /> LceCooler I' 5 Gal Hano wash <br /> Ewa tce Bags d Food Containers must be Waslewaler Container----- - stored 6 inches oPfof the ground) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br /> EHp .6-02 Page S or 11 TEMP EVENT APP <br />