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SAN J O A Q U l N Environmental Health Department <br /> C 0 U N-I-Y—_. <br /> 10. 1 am prc vUnq the following cold temperature controf for the cold holding of potentially hazardous foods below <br /> 45°F(F food is used the following day,maintain below 41'F temperature): <br /> ❑Ice cl lasts ❑Refrigerator , 1 _ <br /> ❑Refri orated truck ❑Ice bath and tubs �LJ <br /> ❑Othe (speolfy} <br /> 11. 1 am pro 'ding the following Items within my booth for the sanitary cleaning of road preparation utensil <br /> OR <br /> E]Three compartment sink. <br /> �.l <br /> ❑ 7hre deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for fs 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 prcvj6ng the following for adequate hand washing facilities, but separate from utensil wash within my <br /> �Wats <br /> t : supply dispenserwith warm water at a minimum of 100°F(i.e.6-20 gallon contalnerwith spigot). <br /> e 1 eparate tub(bucket or basin)for the coliaction of rinselwastewater. <br /> D't''apape towels and pump-style soap container. <br /> 13. Names fr ponsibtersons t be present in booth durfng all hours of operation: <br /> G <br /> "Impo nt" 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 /> preparati n end operall n. urn original to festival coordinator threewes or to <br /> f ' ent / <br /> 14. Complet d by; <br /> [gnature Title Date <br /> rad. <br /> Health Per it tfandwaahwaiar <br /> 6�ama wlCawahq <br /> Ulsh Raper wr><t 7owals - <br /> Sna{+dspansor -_ -- <br /> -- sadrherEucrmt• <br /> bkeGt a water far <br /> — stcnesgwK�rq Uaae <br /> ESatrdi <br /> Propm,a Slaw <br /> Beath must be an <br /> Comet%Asphalt, <br /> 0 <br /> j Plywood,or s Tarp, <br /> ------------ <br /> PftipanaTank <br /> atop AM WaMr R1ma V&W therdr Bid VAW Gerba9© <br /> Can <br /> Flro rAnpuill- <br /> p�Va <br /> Vkrar <br /> ._-It.'ig C�OtBC --�,;�,.,,.. .. :.—"� _—•,� 6rael FlarW wa,h i <br /> i EYlra 1C9 BQ&76TOOd(knfa6rars rtw,rl Cn Wa0ewerer CUS1a`wr <br /> d(W,XfafnrJrra drt+lfirs prn WI <br /> 1865 E.Hazelt n Avenue( Stockton,California 95205 T 209 468-3420) F 209 464-0138 1 www,sjcehd.com <br /> Oil)16-02 papa a of 11 'f E#AP EVENT APP <br /> a'1A117 <br />