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SAN JOANN <br /> Environmental Health Department <br /> ( ` --COUNTY <br /> I;,r;rti,,"S (al'e�niflltss c�r'ufrrs lr�rc•. <br /> 10. 1 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 41T temperature): <br /> ❑ Ice chests ❑ Refrigerator NIA <br /> ❑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 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. l 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 /> xOne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> X Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Rret <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 ori inal to festival coordinator three weeks prior to <br /> this event. owner 1-16-26 <br /> 14. Completed by: <br /> g azure Title Date <br /> H-20 Gel. <br /> Hand wash Water <br /> Health Permit <br /> Sterno wlCharfinp <br /> Dish Paper Hand Towels <br /> Soap dispenser <br /> CuF11n0 Board San h bucket. <br /> ifo <br /> bleach&&water far <br /> Bleach 9lering wlp(ng cr1Wb9 <br /> Propene Stove <br /> Booth must be on <br /> Concrete,Asphalt, <br /> - . �Z Plywood,or a Tarp. <br /> l <br /> F'wl>nna 7nnk <br /> Soap and Water Rinse Weter Bleach and Wolor Garbage <br /> Can <br /> Fire Exllnputeher <br /> Exna <br /> Water <br /> Ice Cf�aierW 5OWHandwash <br /> Fxlre too bags 6 food Confefnors must be Waalawalor Containar <br /> -- - - -- stored 8Inches off of fha groundf <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 www.sjgov.org/ehd <br /> FHS 16-02 Page 6 of 11 TEMP EVENT APF <br />