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SAN J U A Q U I N E'rrivironme tai Health Departmen"L <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 OF 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 /> ❑ 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. c <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 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 rinselwastewater. <br /> xPaper towels and pump-style soap container. <br /> 13. Names of responsible erson o b present in boothlieao I e— Z t 6-n <br /> g all hpurs of o rat' <br /> aE <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 an eration. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by, 11,14 ,l t�rYl_nrL �` <br /> n Title nate <br /> ...• --.... --,r 5-20 Gar, <br /> y Hflnd wash Wain,Health Permit <br /> Sterno wichafrrng <br /> Dish <br /> Paper Manu fOwots <br /> Sony disponsar <br /> CUliinp fioaltl Sand-20f bucket• <br /> bleach L walor!or <br /> Propane SlOvo til0ach slWilin <br /> ingwg OWN <br /> must he on <br /> Concrete.Asphalt, <br /> Plywoocl,or a TP. <br /> fro0ane Tank <br /> 50ap and Water nmsc water Weach and water Garbage <br /> Can <br /> Fire ExImquishcr <br /> Ezlre <br /> water <br /> lcB C✓oolef 5GMMM-4wash <br /> ftka fee Boys 6 Fuer!CUrlralO r5 mus!ba WastowdNr Contatnar <br /> - alored B foclres nfl ul Hca yruundf !� <br /> 1868 E. Hazelton Avenue I Stockton, California 052051 T 200 468-3420 1 F 2QO 464-0138 1 www.sjcehd.com <br /> EFio IG-02 Page a of T, TEMP CVrNT APP <br /> 071311 <br /> 7 <br />