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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <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 41`F temperature): <br /> ❑ Ice chests ❑ Refrigerator <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. 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 I00°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 /> f'15 t`1ki IhGcAl-tom <br /> "Important" All food v or booths are subject to inspection. Please make a copy of this application in <br /> prepara on or this event. copy of this checklist must be in the booth at all hours of <br /> prepara i n nd opera ' n. R urn ori inal to festival coordinator three weeks prior to <br /> this e <br /> 14. Completed by: y"h W <br /> Si nal re Title Date <br /> T - 5-20 cal. <br /> Health Permit Hand wash Water <br /> Sterno w1ChalRrtg <br /> Dish Paper Hand Towola <br /> Scrap dispenser <br /> Culling board Sanitize,bucket- <br /> bleach d water far <br /> Propene Slova <br /> bleach atodng wlping clothe <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rlnae Water Bleach and Water Garbage <br /> Can <br /> Fire Extingutshar <br /> Extra <br /> Water <br /> Ice Cooler �� !':�� T - — 6 Gal Hand wash <br /> Exlra ke Bags d Food Conlainers mus?be Wastewater Container <br /> slored 6Inches off of the ground! <br /> 1868 F. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page a or 11 TEMP EVENT APP <br /> 0710112025 <br />