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r <br /> S A N J O A Q U f N Environmental Health department <br /> 10 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the following day, maintain below 41°F temperature) <br /> X Ice 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 /> ❑ 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 a 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 /> "Important" All food vendor booths are subject to inspection Please make a copy of this application to <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: • 7 L 2-6 <br /> Signature Title Date <br /> 5.20 Gal <br /> Health Perm t Sle Rarnlwaehwa:M <br /> rnowlChaNir* <br /> Dish <br /> Pappr,iyd t:lw�� <br /> Snap dapansnr <br /> G,:t,M ttoud =11"Ult.b1 <br /> 01uarh cAnConcre Asphalt <br /> Ptywood.pr Tarp <br /> / 6tltlp and Wal1'n Riney Walor Mearl+and M11, <br /> Garbage <br /> ,v t.+,ipwctwr Can <br /> walnr <br /> I� <br /> i Ice Cooler atl,awwasrl <br /> i•1,11X,I,.0 10,w,:,u,re,rro,aar:.arhe VVIr laL'wnmr+ <br /> ' Nv[.46,m:haa nlfd ilia preurkY+ <br /> 1868 E Haxelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464.0138 1 www slgov org/ehd <br /> NiO 16 02 Pago 9 pl 11 UMP EVENT APP <br /> 07/01/2024 <br />