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4113/26,3;48 PM wugxNgarsjmsew66nmz.Jpg(3024 4032) <br /> Environmental Health Department <br /> SAN 10AQU�N ., <br /> c�n U�I- �•' k <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below ;-i <br /> 45°F(if food Is used the following day, maintain below 41'F ternperalure): <br /> ❑Ica chosls ❑Refrigerator :t <br /> ❑Refricgerlled truck ❑Ice bath and tubs <br /> ---[!1_0ther(specify) N <br /> 11. f am providing the following items withh m�booth for the sanitary cleaning of focd preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> ❑ Three deep tubs(basins fi-ti 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 /> []oetergent,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: [J <br /> A <br /> Water supply dispenser with warm water at a minimum of 100°F(I.e.5-20 gallon container with spigot). <br /> ❑C)ne separate tub(bucket or basin)for the collection of rinse/wastewater, <br /> ❑Paper towels and pump style sogp container. <br /> 13. Na es 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 tho booth at all hours of <br /> preparation and operation. Return ori lnal to festival coordinator three weeks prior to <br /> this eve t. ! t� <br /> 14. Completed by., f L1 (' {) ?�L('-•i— t I �� <br /> 5fgnature Title Date <br /> v�o sol. <br /> Health Pe,it Hantwash Walai <br /> 8lomo wlCloefling <br /> - 171ah Pnpor Heed Trn+ele <br /> Scap d�spsnaa <br /> Cut.rrh7 hoard $e/11h Itl.wf <br /> (er <br /> bload}&weset <br /> atwinq vripirrp dolha <br /> Propene Slow <br /> En ,'Asph <br /> be on <br /> Fill, <br /> a Tarp <br /> Prcpaaa ror.k - <br /> s soap srvl Welar ninaa Vlatvr Fsleadr and Walar Garbage <br /> Can <br /> Fico FIAInoihnf <br /> EKva <br /> LYnler <br /> Ice Cooler 5Ga1HanUwesh <br /> f_zlra ke 84SS row 00f)1wwrs f7 usl ba WasLawalwr Conllainer <br /> 1868 E. Hazelton Avenue Stockton, California 95245 T 209 468-3420 1 F 209'464-0138 ( www,sjgoV,org/ehdy <br /> DID 18-02 Page a of 11 TWR EVENTAPP <br /> 06119!1 B <br /> htips:llres.cloudinary.com/converitionforcelImage/upload/v'11Gs1268761wugxhigarsjmsewb6nmz.jpg 1 <br />