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S A N "J O A Q U IN Environmental Health Department <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 F. Refngerator <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 /> [Rtetergent. 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 10CT (i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> 21paper towels and pump-style soap container. <br /> 13. Names of responsibie ersons to be prese booth during all hours of operation: <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 festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by; - .2 Y. 2-O� <br /> Signature Title Date <br /> 5.20 Gal <br /> Health Per Nand wash water <br /> mit <br /> Pacer r-.,r..'wre is <br /> Sacp Gs:enser <br /> sar:i <br /> e buck <br /> Ciear.),6watef ette- <br /> r <br /> p oeare Stove I ileac storing x4ping cloths <br /> 1 ; � <br /> Booth must be on <br /> i Concrete,Asphalt. <br /> Plywood,or a Tarp. <br /> •apane Tarp <br /> Soap ara Nater Rinse Water 9leacr.ana 'ia;ar <br /> w F'' Garbage <br /> Can <br /> �me Ea'Ciri,VSl+B <br /> Ex:ra <br /> water <br /> Ice Cooler Fxa i per r ,1 5 Gal Hand wasr <br /> 3aas B Foaa C .a ,; wastewater Coqarne- <br /> 1868 E. Hazelton Avenue 1 Stockton California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 16-02 Wage b i t TErAP EVENT APP <br /> I-—nn» <br />