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Aft <br /> ,NNW 141111111111111F <br /> SA N 10AQ U 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 /> 45°F(if food is used the following day, maintain below 41°F temperature)-, <br /> AIce 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 /> tB�Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> sot Lion(one tablespoon of bleach per gallon of water). <br /> Detergent, bleach,and wiping cloths(cleaning towels). <br /> rub 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 /> ,-XWater supply dispenser with warm water at a minimum of 100"F(i.e. 5-20 gallon container with spigot). <br /> XOne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> / `Paper towels and hump-style soap container. <br /> 13. Names of responsible persons to be present in booth durin all hours of operation; <br /> r <br /> Import AI food ndor 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: <br /> ignat a Title Date <br /> 920 Gel <br /> Health Permit Handwash Wale, <br /> Slprnn wrChalfirg <br /> D,sh <br /> Paper Hand Towels <br /> :N1aD dinpensar <br /> 1:u11in0 Baard Sanrtzer bucket- <br /> bleach&walar br <br /> Propane store 9leach slonon- o g cloths <br /> Booth must be on <br /> Concrete.Asphalt, <br /> Plywood,or a Tarp. <br /> Prooarro Tank - <br /> soen and water Ix n.a walar e+.�O a i water Garbage <br /> Can <br /> fve Fawnalxaf+ar <br /> Exua <br /> W alai <br /> Ice Cooled - 5 Gal Hand wash <br /> Extra ka Roos d Food Cnolaaners mnrst be Wastewater Container <br /> --- - -- 5rored a hchas off of the ground <br /> 1868 E Hazelton Avenue I Stockton. California 95205 j T 209 468-3420 R F 209 464-0138 1 www sjgov org1ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 07/0112024 <br />