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SQWMAQUIN Environmental Health Department <br /> - -� aur,1 <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 11114 <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 /> 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 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 /> LliL-Ii�r i to-5, <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 iperation. Return original to festival coordinator three weeks prior to <br /> this event. <br /> '34. Completed by: <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash water <br /> stereo wfGhatrutg <br /> Dtsh <br /> Payer Hanc Tpxetp <br /> Soap dsoenser <br /> Gutlinp 9oare Sanitize'bucket <br /> bleach 8 water sor <br /> Psppane Stpve &each storing wiping cloths <br /> dcwlh m�vt b�on <br /> Concrete,Asphalt, <br /> NU <br /> ,., r'_ Plywood,or a Tarp_ <br /> PfDoane Tank <br /> Soap and Wdsef Rinse Wafer Bleach and Water Garbage <br /> Can <br /> FIfQ 1:7('3npL't5hef <br /> E7�a <br /> YJatwr <br /> Ice Cooler <br /> 5 G81 Hand wash <br /> -.-__-- .. Y._.I I bdro Ice&wx&Food ContafnersnuWbe WastewaterContainm <br /> / stared&'etches off of the gnumdl <br /> 1868 E. Hazelton Avenue l Stockton. California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> FHD 16.02 Page 8 of 11 TEMP EVENT APP <br /> 06119119 <br />