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SAN JOAQUIN Environmental Health Department <br /> I <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45OF (if food is used the following day, maintain below 41 eF temperature): <br /> ce chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑ Ice math 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 /> Throe deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> �solu n (one tablespoon of bleach per gallon of water). <br /> �tergent, bleach, and wiping cloths(cleaning towels). <br /> b 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 /> ❑i 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 /> Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> .Wuc .131'Y1U, 6:-,k;7-1­lc'g =- / `-;cam <br /> *'ImportanVft 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 Plior to <br /> this event. <br /> 14. Completed by: oyury'.K_ <br /> Si ture Title Date <br /> 5-20 Gas. <br /> Health Permit Eland wash Water <br /> Sterno wlChaffrg <br /> Dish <br /> Paper Hand Tovrels <br /> Snap dispenser <br /> CrrNing Board Senit¢er bucket <br /> bleach 11 Vale?for <br /> Propano Stave <br /> Bleach storing wiping dolhs <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Wafor Rinse Water Bleach end Water Garbage <br /> Can <br /> Foe Extin"shcr <br /> Extra <br /> Water <br /> Ice Cooler 5Gal Hand v sh <br /> Extra Ice Begs Q Ford Contac ws mus!he Wastewater Container <br /> sfwed 6 inches of d MR ground! <br /> 1868 E Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 I www.sjgov orglehd <br /> EHO 16-02 Page 80111 TEMP EVENT APP' <br /> 07/0112024 <br />