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S A N ,J 0 AQ U I N Environmental Health Department <br /> C_OUN1 Y <br /> t trh,x•��� Wrrrlisv%l Irtlliv% herv. <br /> 10• 1 am providing the following cold tomperalum control for the cold holding of potentially hazardous fonds below <br /> F(if food Is used the f0110%kring day,maintain below WF tempornturo): <br /> le chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑Ica bath rind tubs <br /> ❑Other(specify) <br /> 11• t y(providing the following Items within my booth for ilia sanitary cleaning of food preparation ttlanstl <br /> OR Three compallmonl sink. <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,bieacli,and wiping cloths(cleaning towels), <br /> ❑Tub to stone 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 /> Not 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 rinse/wastewater, <br /> E,/Paper towels and puma-style soap container. <br /> 13. Names of responsible persons to be present In booth during all hours of operation: <br /> W tL'V- atLo I►-JC-t- <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: �^- �tJJI..r 47,YL q 13 2-0 1-3 <br /> Signature Title Date <br /> 6.7G Od- <br /> Health Perm€t R,ne wash wal.r <br /> Stsrl7e xSCh.RhQ <br /> drrh <br /> Paper Hand Town <br /> Snap peponaar <br /> CUWO aoa" SanhW r Oucl\et- <br /> Waach 8"lor roe <br /> raw"Slave Blaerh dares Wpk,q chief <br /> Booth must be on <br /> Concrete.Asphalt, <br /> t Ptyevood,or a Tarp. <br /> Piq]aM Tarr <br /> Soap en0 Water R"s Water Bleach cry warm Garbage <br /> Can <br /> Flry EninpJ0 <br /> Ei4r6 <br /> Vloler <br /> Ice Cooler 6 Gal Hand wash <br /> 1-0fa ka 14go Q Food Gonlatnan rrarrl be WasteWelar Contdaer <br /> dond dlnrhea all dfha prwaeT! <br /> 1868 E,Hazeilon Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjg0v.0r91ehd <br /> EM 16-02 MOO a of 11 TEMP EVENT AP. <br /> nai,rrsn <br />