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',. SANA UIN Environmental Health Department <br /> �if1f(►tn►St< �rt1lr! l+trrtl <br /> % 1 elm pmrMing Me following cold temperature control for the cold holding of potentially hazardous hoods below <br /> 45*F (if food Is used the folowing day, maintain below 41"F temperature): <br /> ❑Ice chests t6�ftefrlgwvw <br /> 0 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 /> [a Three compartment sink. <br /> QR <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 /> 112. t 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 100aF(i.e. 5-20 gallon container with spigot). <br /> C70ne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pumwstvle soaa container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> tN�� <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 orlor to <br /> tfifs event. <br /> 14. Completed by: <br /> ignature Tine D21e <br /> 5-20 sx <br /> Haig wash Water <br /> Health Permit � <br /> ❑rah Paper Hand Towels <br /> Sow dapenser <br /> Sanitzrs bu"t <br /> CrEt*YI � bk%Kh 6 water for <br /> 5'Mrq-Pn9 dolhs <br /> Blearfc <br /> pnmarr Store <br /> $oval must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> prown Tel* <br /> Soap amweler Rasa Water BleachwW Wafer Garbage <br /> Can <br /> Fr Uk)gwsher <br /> �"y Eris <br /> Walex <br /> ice Cnvl@r 5 Cal Hwidwash <br /> Extra ka 8ara 6 Food Coats is mutt be Waslavraler Contariri <br /> atawd 6:nMas all d ffe ground, <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 > www.sjgov.orglehd <br /> EHD 16-02 Page 6 of 11 TEMP EVENT APP <br /> 06/19119 <br />