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k SA N JOAQUIN Environmental Health Department <br /> -COUNTY <br /> v - <br /> +r..:a;=w "'rentness grows her. <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'F temperature): <br /> ❑ Ice chests gRefrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I yn providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR Three compartment sink. <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 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 rinse/wastewater. <br /> ❑ Paper towels and Pump-style soa container. <br /> 13. Names of responsible persons to be present in booth durin a!! hours of operation: + <br /> "*Important" All food vendor booths are subject to inspection. Pleas 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 on linal to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: <br /> Signature Title Date <br /> Health Permit s-zo Gal <br /> Sicrno wlChatlmg Band wash`haler <br /> Dish <br /> r'apnt Hpno rowels <br /> Soap dispenser <br /> Cuarng Board <br /> SarubLer Ouckei- <br /> t4each$water far <br /> Prnpane Stave —Meach slonng wiping cloths <br /> 8aolh must be on <br /> Concrete,Asphalt, <br /> O Plywood,or a Tarp. <br /> Propane Tank U <br /> Soap and Wafer R rise Wale, 6leactr and Wafer <br /> Garbage <br /> Fire ExUnguisner Can <br /> Exlra <br /> water <br /> Ice Cooler <br /> s Gal Hants waste <br /> - / Extra Ice Hays 8 fb d Conlxnars must be ,tik Wnsfaw+ller Gortainar <br /> stared 6 inches off of the grormdr <br /> 1 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EHD 18-02 <br /> 07i3f17 Page 8 of 11 TEMP EVENT APP <br />