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SAN J OAQ U I N Environmental Health Department <br /> C0t.ltitTY - <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 /> 01Ice 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 /> El compartment sink. P pt <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 /> Je'Waler supply dispenser with warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot), <br /> Kone 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 /> A G ES U f u[At" <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. Return original to festival coordinator three weeks prior to <br /> this event. S��S r�/. I � <br /> 14. Completed by: f 61 <br /> Signature Title hate <br /> --Hea--- — <br /> lth Permit I He d v,ash W.tur <br /> SiamovrlCheX'ng <br /> Paper Hand Towels <br /> Seep dispenser <br /> Cu[Ung aex4 SanUmr buckel• <br /> bleach d Water ray <br /> PraAa<la Stove Bleach stating vRpkV dohs <br /> -� Booth must be un <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propene Tank <br /> Soap and Water Rkna Water Bleach and Wale Garbage <br /> Can <br /> rlre ExikpN4hes <br /> Extra <br /> II 1 Water <br /> r1ceooler I ] -- 5 G1 Handivesh <br /> E Extra Ica Bags 6 Food Cdnldners must ee Wauewater Containar <br /> 11 sNrN i Arches oN W(he UANOW1 <br /> 1868 E. Hazellon Avenue I Stockton,California 952051 T 209 468-3420 I F 209 464-0138 1 www.sjcehd.com <br /> EM)15.02 Page a of i 1 TEMP EVENT APP <br /> (1773!17 <br />