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SAN JOAOUIN Environmental Health Department <br /> - COU N-rY <br /> 10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(if food is used the following day,maintain below 41 eF temperature): <br /> ❑ Ice chests efrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11. I pp viding the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Pam ree 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 /> ❑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 /> ��hater supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> L rO-ne separate tub{bucket or basin)for the collection of rinse/wastewater. <br /> ull(apex towels and aum"!yle soap container. <br /> 13. Names of responsible persons to be pr sent in 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. Retum original to festival coordinator three weeks prior to <br /> this even <br /> 14. Completed by: —df 'I,e r L/— <br /> Signatur Title Date <br /> b20 Gal. <br /> Health Permit fiend wash waler <br /> san,a..rcn.rltry <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutllrg Bmrd <br /> Sariliizer buHlat- <br /> Dleach&watefim <br /> PfepaM SLWa Bleach strong wiping owls <br /> Booth must be on <br /> O Concrete,asphalt, <br /> Plywood,or a Tarp. <br /> Propene T-1 <br /> Saap and Water Rinse Waler Bleach and Water Garbage <br /> Fire F.>mllpuisher <br /> Can <br /> Eldra <br /> Weler <br /> Ice Coolei~ I 5G2l Hand wash <br /> Extra fco Saga d food C Mane,s must be I Wastewater contaner <br /> -... ._._ .-._. _ sln.od 6inCM.aIl allha�q.✓,dr <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 ! T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EF1 Page 5 of 11 TEMP EVENT APP <br /> 06119,19 119 <br />