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i <br /> r <br /> S A N,-J OA Q U I N Environmental Health Department <br /> COUNTY <br /> 10. 1 am providing the following cold temperature control for the Gold 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 end 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 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 700°F(i.e.5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> ❑Raper towels and pMmk§We soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Rarnadptta Sptmncpr <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 o ration. Return original to festival coordinator three weeks prior to <br /> eve114. Completed by _30" Owner/Operator f <br /> gnature Title 15ate <br /> spa c.L <br /> Health <br /> oix, <br /> soaad : <br /> +w eo.na a. <br /> M Is veawl for <br /> PMQWASvm sued, w�4t'adoita <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> '0 andWtnr Rhwe Water B�Cit and WNer ��� <br /> w Can <br /> Extra <br /> Ytalar <br /> Ice Cooler ' er.irW,a+ <br /> Extrt ke sea 6 Awd Cwftkwrt nVM be Watlw�alr Coe w <br /> t0ortd 0 YrcMe o�ditx grotd <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 T 209 468-3420 F 209 464-0138 E www.sjgov.orgtehd <br /> EHD 16-02 Page a d 11 TEMP EVENT APP <br /> W19119 <br />