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S A N i O A Q L 1 N Environmental Health Department <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457 (it food is used the following day, maintain below 41'F temperature): <br /> ❑ Ice chests Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> 0 Other{specify} ;-z ; Y.f =_�::- :r&T <br /> 11. 1 am providing the following items within my booth for the sanitary cleaninc of food preparation utensii <br /> M Three cnrnpartment 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 /> 71 Detergent, bleach, and wiping cloths(cleaning towels). <br /> °L 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 10r?°F f i.e. 5-20 galleon container with spigot}, <br /> ❑ One separate tub (burket or basin)for the wIlect(on of rinseiwastewater. <br /> r <br /> I Paper towels and puma-style spa ta container. <br /> I 13. Names of responsible persons to be present in booth during all hours of operation: <br /> �/`ri tC. �S.��a V�•{( 1. (" Cy Ta. LtC <br /> i <br /> —Important" All food vendor booths are subject to inspection. Please make a copy of this application 11) <br /> preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operation. Retum original to festival coordinator three weeks prior to <br /> this event. f <br /> 14. Completed by: <br /> Signature TW16 Date <br /> Health Permit r{:ncv,yEh'n'e+cr <br /> �iciCLS:IVr� <br /> ~Jr.=tr, � ��c�in1 TcwtEs <br /> sale d�er.asr <br /> C�:linp 5:.sd Sanrvv 6�dtd- <br /> Nl1Lh d ti'at8rl(1' <br /> ;m,ing wirirg dbin= <br /> Hr[aanF�4i"r, 33CJLf. <br /> Rrxllh muss be on <br /> Y Concre[e,Asphalt <br /> Plyv�oua,era Tarp. <br /> 1-rnEirk <br /> .. -Jl a:con t'izt¢r RIr3C'rdav^r @Ivv:,n err{':�kr Garbage <br /> Gan <br /> Fat.,E.Iav her <br /> Enre <br /> �ria'zr <br /> Ice Cooler .e6.5&+ae -r 9 GtJ 61."d rreah <br /> j�• Fri•a Jrs Bs,7x E Fclutl C�nrch_K?rnu!t he '�'la.tar�ier Ccrtl�ncr <br /> 1866 Nazolton Avenue I Stockton, California 952051 T 209 468-3420 F 200 464-0138 1 %trww,sjgov.orglehd <br /> t HD 16-02 Page B ui S y I UIP P%!ENT APP <br />