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S A N 10 A Q U I N Environmental Health Department <br /> ' + COUNTY <br /> Greatness grows here. <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 t5 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 /> OR '�A 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 soap container. <br /> 13. Names of sibit pe sons to be present in booth during all hours of operation: <br /> �i d!f l/Y)u/e/cS <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 ev nt. <br /> 14. Completed by: <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash Waler <br /> starno w1chalFlng <br /> Qish <br /> Paper Hand Towels <br /> Suap tli5oenser <br /> CuRinq Board <br /> Sarolizer bucket- <br /> bleach&water For <br /> Propano Slovo Bleach storing raping clnths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Prnuano TanV. <br /> Soap and Water Rinse Water 819ech a-mf Waler <br /> Garbage <br /> Fire Exfin(}Uisher <br /> Can <br /> Extra <br /> Water <br /> Ice Cooler 6GelFlandwash <br /> Extra Ice Bags&Food Containers muse be Wastewater Gonlalner <br /> ~-- —- - --- stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ' F 209 464-0138 J www.sjcehd.com <br /> END 16-02 Page 8 of 11 <br /> 07l3117 TEMP EVENT APP <br />