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SAN J OAQ U I N Envilivnmentai Health Department <br /> -r v- <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 water, one for rinsing and one for a bleach <br /> (� Three deep tubs (basins 8-8 Inches rriinimuan), one for soapy 9 <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 ani providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> R Water supply dispenser with warm water at a minimum of 100'17(Le. 5-20 gallon container with spigot). <br /> _40ne separate tub(bucket or basin)for the collection of rinselwastewater. <br /> a Paper towels and pump-style sea container. <br /> 13. Names of responsible persons to be present in booth during pours of operation: <br /> NT'-Ye <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. Retum original to fes ival coordinator three weeks Prior to <br /> this event. <br /> C9lV,-z 4?s' "/ r Z' 2'6 <br /> 14. Completed by: r <br /> Signature Title Date <br /> rL <br /> 690 UPI, <br /> alth PermitMach <br /> Arcxane Slavu <br /> Fso,o,l must be an <br /> ocrete,/laph".ywood,or a Tara. <br /> PropaaeTnnk __ <br /> Soup andwnrer rih,a wafer 131eacn and water Gef bags <br /> _. Gen <br /> �- <br /> Fire E+din;NPeILI <br /> D.."r <br /> Ice Cooler I I r I 61101 ffand wash <br /> &nal;:nLia�sdFaxrCOMmfltrarnuarDu yPaafawalwCantenor <br /> afaveu a rncr:as ef!et fr,n yraund! <br /> 1868 l;, Hazelton Avenue I Stockton, California 952051 n r 249 468-34201 F 209 464-0138 1 www.sjcehdI I TE MPEcom ENTAPP <br /> f=hlD 10•01 <br /> 0713117 <br />