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S A N . 1 Q AQ U I N Environmental Health Department <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(if food is used the following day,maintain below 41'f=temperature': <br /> Ice chests ❑Refrigerator <br /> ❑ efrigerated 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 wi th warm ,rater at a minimum of 100'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-sl a soa container. <br /> 13. Names of responsible persons to a present in booth during all hours of operation: <br /> �,SSt r S N <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 nd operation. Retu on inal to festival coordinator three weeks prior to <br /> this event. <br /> Completed by: I C(' v 9 3 a -.�°)-1-7Signature Title Bate <br /> Health Permit <br /> a;e+no a aJB'+iq <br /> liar Tow,de <br /> GiAfNW 3#CYJG :yikJ.'tlf Ct1Lt•MF <br /> Y:{rli::Vi�w.Y4ar�M <br /> Mt�pf4r eJm'td �$1 5t�1Mj M1fKY�fj,+{;?$ <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood.a:a Tarp. <br /> ?eOD%tAe Ta/f'k <br /> SnwD Y.•+ct W:se+ Ranx Waf r 81e.F:tt. %vm~" Gart>akc <br /> iftaE�tK;wt,cr <br /> Cat, <br /> �ttltM <br /> 4Yates <br /> —licear edb-vA*sv#o/IAerv—%ft <br /> 1868 E. Haz lton Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464.013g ) WWW:S,gcov.orglehd <br /> END 16-02 paw a of 11 TEMP EVENT APP <br /> 071)112424 <br />