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SAN.00AQUIN Environmental Health Department <br /> ;= --COUNTY <br /> as <br /> 10. I am providing the following cold temperature control for the cold holding of potentlaliy hazardous foods below <br /> 454F(if food Is used the following day,maintain below 41"F temperature): <br /> [ tee chests ❑Refrigerator <br /> ❑Refrigerated truck ❑ice bath and tubs <br /> ❑Other(specify} <br /> 11. I am providing the following Hems within my booth for the sanitary cleani?1! <br /> preparation utensil <br /> ❑Three Compartment Sink. WA-No sncrtr rA11 ftPa`. I <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 /> ER 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 tinse/wastewater. <br /> [ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Adriaaa MadirwR: <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. Retum o i�nal to festival coordinator three weeks prior to <br /> 14. Completed by: _owner 1M178 �� <br /> Signafiad Titte Date <br /> saa c.a <br /> Health Permit <br /> s�,o,Mcrrire <br /> oh <br /> pow Now T*M <br /> sew eeva�ar <br /> ea.e sr «ha%s�- <br /> hb.a+a vAiw k r <br /> PMP—9ror• MOM °oC" <br /> Booth must be on <br /> Comets,Asphalt <br /> - Plywood,or a Tarp. <br /> PropwuTMdc — —- - <br /> lkrp.new5il.r RYr.rY.rr airaiwrfNMer <br /> Can <br /> tea. <br /> virir <br /> Ice Cooler SGN ,aw <br /> E%ftA=at=sradc&t.hmmatto Nlrurrdwr <br /> ob r <br /> 1868 E.Hazelton Avenue 1 Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br /> EM IM Page e d ti TEMP EVENT P" <br /> t1Ert Wf9 <br />