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f <br /> i <br /> SA N' 0AN I 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 trans <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 /> Oft <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.e.5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> ❑Paper towels and pump- soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Joe Spencer jif S _ <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 na fe tiv I c ardlnat r this week rior to <br /> this a ent. <br /> 14. Completed by: Owner/Operator <br /> Sign (S Title Dates-ao cam. <br /> Health Permit M"wf hwow <br /> slen,o wfdnrtfnp <br /> owl Pam>{ind TtfweLS <br /> Sow d3�etexr <br /> CfRlkq Baird SaN6zer h>zlcet- <br /> Mead iwafarW <br /> Propene SZ" abeam 0XV4_4M dnl1R <br /> Booth must be an <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propene Truk - - <br /> SoipendWSW lilmeweMr 8teediendwater Garbage <br /> Can <br /> �atri <br /> Ice Cooler Fs�ktriess la6l B>c.hDeer a <br /> 5 <br /> WM <br /> Fnd <br /> .1 nitb R� <br /> -117 <br /> 1868 E.Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov.orglehd <br /> EHD 16-02 Pipe sot 11 TEMP EVENT APP <br /> MAWS <br />