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SAN JOA QUIN Environmental Health Department <br /> c"'OLJNT\I- - <br /> i, is , tr�,..; ll• r <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 4,5°F (if food is used the following(Jay, maintain below 41'F temperature): <br /> XIce chests X Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. 1 m 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. l am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> Awater supply dispenser with warm water at a minimum of 1004F(i.e.5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ❑Paper towels and pump-style soap container. <br /> 13, flames oof.��nsi a persons to be present in booth during all 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. Return original to festival coordinator three weeks prior to <br /> this <br /> 14. Completed by: , dtyllex l� <br /> Signature Title Date <br /> 5.20 Gal <br /> Hand waif+Water <br /> Health Permit <br /> Sterno wlChalfing <br /> ❑ish <br /> Paper Hand jewels <br /> Saab cFisponsor <br /> Cutting Pinard &w.tgor bucket. <br /> Fr wh d water for <br /> Propnno Strvu Bleach storing wiping r1Whs <br /> Booth must be on <br /> n Concrete,Asphalt. <br /> Plywood,or a Tarp, <br /> Ymlrano Tank <br /> SOdP and Watnr limse.Wato 91earh"'W Wald Garbage <br /> Can <br /> [Fire Fxt ngu,ahar <br /> Extra <br /> Water <br /> Ice Cooler s�arfwndwa5tr <br /> Er7ra ke Bags&Food Containers awsf ao M.astcwatnr�rrun+r <br /> - slaved-mUres off of rhe grormdr <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 J www.sjgov.orglohd <br /> FHO 18-12 Page 8 of 11 TEMP EVENT APP <br /> 0&2912.023 <br />