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SA Nd OAQ U I N Environmental Health Department <br /> C: 1 <br /> COUNTY <br /> r <br /> f c�ri4 Greatness grows here, <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> i 45'F(if food is used the folfowing 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 /> M 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 /> [9 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 /> [A Water supply dispenser with warm water 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 rinsetwastewater. <br /> i <br /> i <br /> Paper towels and pump-style soap container. <br /> I <br /> 13. Names of responsible persons to be present in booth during a!l 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 the booth at all hours of <br /> preparation and operation. Retum original to festival coordinator three weeks prior to <br /> � this event. <br /> 14. Completed by: G�.t]Y1e►� 1 20�(p <br /> Signature Title Date <br /> 5-�0 cal <br /> Health Permit HandwabhWarer <br /> � Stamo wrChaNng <br /> Dish <br /> Paper Hand Towels <br /> Soap dlQpQnaer <br /> Cutting Board Sanrl¢er bucket- <br /> bleach&water far <br /> IPropana S:ova Bleach slorfng wiping doss <br /> I <br /> Booth must be on <br /> Concrete,Asphalt, <br /> _Q, Plywood,or a Tarp, <br /> 1a1„ 5'R .j.. .� <br /> PrapaaQTenk <br /> •+! Soap antl Water Rlnoo Woter Bleach and Water Garbage <br /> ! Can <br /> Fie ExlinPalahar <br /> •• 6rUa <br /> Ice Cooler Seal Handwash <br /> Exim Ice Baps d Food Conretnars must ba Wastawaler Container <br /> stored a rnChpS Ctr otthe gruund7 <br /> 1866 E. Hazelton Avenue J Stockton, California 95205 J T 209 468-3420 F 209 464-0138 J www.sjgov.orglehd <br /> EHO 16-02 Page B or 11 TEMP EVENT APP <br /> 07/0112025 <br />