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S A N -,J O A Q U! 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 /> 45aF(if food is used the following day,maintain below 41°F temperature):41+❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. 1 4M 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 handwashing facilities, but separate from utensil wash within my <br /> booth: �3 <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 persons3tg 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. f� �.... <br /> 14. Completed by: <br /> Signature Title Dat <br /> 5-26 Gal. <br /> Health Permit Handwashvlater <br /> S[emo m'ChafGng <br /> Dish Paper Hand Towels <br /> Seep dlspenscr <br /> Gulling 9aarri Sanhacr bueket- <br /> bleach S water for <br /> Propane S!avp <br /> Bleach stoning wiping dolhs <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Ptooane Tank <br /> y,„�. Soap and Nlaler Rinse Water Bleach end Wa[er Garbage <br /> �' Can <br /> Fire6diMulaher <br /> Ice Cooler '�' `•' "`•'� -"'-�.- 5 Gal Hand%vash <br /> Extm Ice <br /> Bags&FoatConfalnersmustAe�! Wastewaterf.`antalnnr <br /> stared 6lnches offoflho ground! <br /> 1668 E. Hazelton Avenue I Stockton,California 95205 IT 209 468-3420) F 209 464-0138 1 www.siElov.org/ehd <br /> EHD 1e-02 Page B of 11 TEMP EVENT APP <br /> 05119119 <br />