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v� <br /> c y- SAN�jJUAQUIN p <br /> �- �- °� Environmental Health Department <br /> , <br /> —COUNTY— <br /> t � Greatness grouts here. <br /> 10- 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(if food is used the following day,maintain below 41 eF temperature): <br /> ❑Ice chests V Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> Other(specify) (2O]tr-nlyt�n/f7 <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(leaning towels). <br /> Wlrub 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 100eF(i.e.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. N mes f responsible persons to be presenj in booth dudng 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 /> Signature Title bate <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Stem wlChatrmg <br /> Dish <br /> Paper Harts Towels <br /> Soap dispenser <br /> Cull6rg Hoard Sant::—bucket. <br /> bleach 6 water for <br /> propane Stow Bleach storing typing cloths <br /> Booth must he on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Prapane Tank — - -- <br /> Soap and Water Rinse Water Bleach and Water Gatage <br /> ell` Can <br /> Fire 6din4uisher <br /> @rdra <br /> �,1' Weter <br /> Ice Cooler 5 Gal Hand wash <br /> urea r a.ya a Foot conbsr.,a musr ev wastewater ConWnm <br /> stored 6Inches o}rofthe ground! <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 i T 209 468-3420 l F 209 464-0138 l www.sjgov.org/ehd <br /> EHa f B-02 Page 8 of 11 TEMP EVENT APP <br /> 06/19/19 <br />