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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> 10 1 am providing the following cold temperature conlrol 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 ®tce 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 Goths 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 rinselwastewater. <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 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 /> Slgnat�r� Title 'Date <br /> S20 <br /> Health Permit Mandwash Waw <br /> sramo�cnalr�y <br /> (hsr <br /> Paper ttantl 7oweh <br /> soap espeuwl <br /> CUn+r+q Board sanmzer buchel. <br /> plea-a water sa <br /> Prepare Sl�ra <br /> ffi.aCn sta nq w�+np dol»s <br /> Booth must be on <br /> Concrele,Asphalt, <br /> Plywood,or a Tarp. <br /> $UdP a"d Ylalor u.eso wait. B,ea: ass v.ac Garbage <br /> Can <br /> Piro E.tnuon nor <br /> r Yi 1'C' <br /> Ice Cooler 5Gal Nand[-,Am <br /> and wash <br /> EAm Ice Baps d rood Canfa+nan must be Wastewater <br /> re Canla++ar <br /> Srod E»che s o7!or Use prtwnd' <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> EH0 16-02 Page 8of 11 TEMP EVENT APP <br /> 06/19119 <br />