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t <br /> � ' �.��Q���N Environmental Health Department <br /> ----COUNTY <br /> ��. Grecrotss grows hers- <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> OF(if food is used the following day,malntaln below d1't"temperature): <br /> Ice chests ❑ Refrigerator <br /> Refrigerated truck 0 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 /> ❑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 watery. <br /> C)Detergent, bleach, and wiping cloths(cleaning towels). <br /> LJ Tub to store wiping Goths in bleach solution <br /> 12, 1 ar, 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 /> (/O,ne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> LP Paper towels and umo-s le soar container. <br /> 13. Na as of responsible persons to be present in booth during all hours of operation: <br /> GL <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: 4611440 j2L <br /> Signature Title Date <br /> 5.20 cal <br /> Health Pe. "a"d'"a6h'�ay' <br /> Soema.arxa.7m9 <br /> OEM <br /> Fapar"and Tawts <br /> Sos?ditpensa <br /> CiR'arq Board S.14.hwd t <br /> b:sach a WOW* <br /> Propane Sbve 6lsach <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. i <br /> i <br /> Spay and WNr rank a!sr Bleach and Wale Garbage <br /> s <br /> Fire E)Gwyrsihw Can r <br /> Erva <br /> Wear <br /> i <br /> Ice Cooler ' <br /> 5 ON Nand wsafi <br /> Errra Ias espy 6 Food CoWanon nwit M waNswslsr coasnw <br /> standakWwolforthegm ndr <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 488-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHp 16-02 P TEMP EVENT APP <br /> r1sr79n9Page B Of 11 <br />