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f"- SAN,-, J 0A0 U 1 N Environmental Health Department <br /> i i`N °tr --COUtilTY <br /> ":.K•rr: rayl- Gareotness (crows herl:. <br /> 10. i am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F;(if food is used the following day, maintain below 41'F temperature): <br /> ❑lee chests ❑Refrigerator <br /> x❑Refrigerated truck ❑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 dnsing and one fora 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 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 persons to 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, --- <br /> 14. Completed by: � ���� st.�" Owner/Operator � ) <br /> 1, Signature Title mate <br /> s-2o cal. <br /> Health Permit HarxtwoshWatw <br /> Slarna wlChelfing <br /> Qish <br /> Paper Harsd 7owrl5 <br /> Soap dispanacr <br /> Culling 9oard 3a Uxw Iwckat- <br /> bleach 6 water for <br /> !'capons SlOvo <br /> Bleach staring Wiping clolhs <br /> Booth must be on <br /> - - --- — Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> K <br /> Propane Tank 7 L� --4Cf- Cli. € s?��a,;^;s -'l.l• a."� �c F':: r-f -"_::5;�a, <br /> Suap and water Rinse Water Bleach and Water Garbage <br /> rs <br /> N tJen <br /> Fire FaNnpulsher <br /> i �' Wzler <br /> Ice Cooley ;I W shoal Ha d"'o'ontailer <br /> fixirn!cn Lftrgs R Food Gonlaincrs roust he <br /> alarod 6 f rchas ol/of lha flroundr <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 F 209 464-0138 I www.slgov.orglehd <br /> EFID 18-132 Page B of 11 TEMP EVENT APP <br /> 06H 9119 ' <br /> i <br />