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Q Environmental Health Department <br /> CnUNTY <br /> �c^ Fes„ Grp,. :Qss grows h&fc. <br /> 10. 1 am pr Irig the following cold temperature Control for the cold holding of potentially hazardous foods below <br /> 4 (if Food is used the following day, maintain below 41°F temperature): <br /> Ice chests ❑ Refigerator <br /> ❑ReftKjerated trvctc �tari airld t1 des <br /> ❑Dew($PAY) <br /> 11. 1 am providing the f+ouawing items within my booth for the sanitary cleaning of fraud preparation utensil <br /> ❑Three compartment sink. <br /> OFF <br /> ❑ Three deep tubs (basins 6-8 inches minimum), one tar soapy water, one for rinsing and one for a bleach <br /> sdo onEone ta0�of bleach per gallon of water). <br /> D"aM hied,andwping cloths(cJeanmg towels). <br /> Tub te:storeMpffV cloths in bie22 sot s <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> E V1 -er supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> [,'�Qne separate tub(bucket or basin) fnr the cdlacban of rinseNvastawater. <br /> 0Pa towels and pum sit l _sapp container. <br /> 13. Names of responsible persons to be present in tooth during all hours of operation: <br /> efS c' C� rnd IU \iL - --- <br /> 11ayw<, ftli.,65u rP A---- <br /> "'tmporta rt!" Alt food bboths are s,uboct io inspection. Please make a copy of this application in <br /> preparation for this event- A ropy of this ctoeckfiist must be in tt* booth at all hours of <br /> preparaliion and.dp ra W k!to 0Mtt ME-C*ardbLWf _ trs <br /> this QVIM <br /> 14. Completed by: �•�C'r <br /> NUt-ch 5 2026 <br /> Signature TMe Dabs <br /> Health Permit <br /> l� 'PcprF�E�greta <br /> soap c+Panser <br /> Ulqgiioatf 5rxze+lNr�cal- <br /> 333 6bach&water for <br /> PmpYe Slone <br /> 41aa.cii slortnp rrtping cloths <br /> Booth must be on <br /> Gonaete,AsgY+alt, <br /> Plywood,or a Tarp, <br /> Prgpr T.Ok <br /> s-9 O(1Q wam - Rose Waier $t[wY and Walcr <br /> a <br /> u t Call <br /> Frra Edx�raF+er <br /> pp� Extra <br /> ii� YVeter <br /> lots'coole4 5-Gal Hw4d cad <br /> Emsloeypedr-Waloopmwa�Raa YhtastrrelarCoNaner <br /> aHl�fi Ac1lYs d oI Mle plalM3' <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> F.HD 16-02 Page B of 11 TEMP EVENT APP <br /> 0713117 <br />