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S A N J O A Q U f N Environmental Health Department <br /> COUNTY <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 <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 /> E Detergent, bleach,and wiping cloths(cleaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. I 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 rinsetwastewater. <br /> ❑x Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> (dress Amin <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 an operation. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash water <br /> StemoD hhaHrn9 NEW INDIAN SUPERMARKE <br /> 3350 N Paper Hand Towels <br /> � m <br /> Gutting Board TRAC <br /> Sandizer 6ucket- <br /> (209) 39 bl"cn a water sor <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> i'fopann 1 ank <br /> Soap and Watc. Rrnse Water Bleach and Water Garbage <br /> Can <br /> Fin:Fxt7nciuisher <br /> Fzlra <br /> Water <br /> l <br /> Ice Cooler 5 Gat"and wash <br /> Extra fce Bags a Facrd cwfaor s must be wastewater Container <br /> stored B imt olrorthe ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 R www.sjgov.org/ehd <br /> EHD 16-02 Page S 0111 TEMP EVENTAPP <br /> 07101=25 <br />