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r <br /> S A N:J a Q Q U I N Envir®nmontal Health Department <br /> '.i;= ...., COUNTY- -- <br /> i+., Gredness gfotv5 hprc. <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 ❑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 /> Q 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 rfnsetwastewater. <br /> E Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> oun Ouk & Lrnfly Ouk <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 on Inal to festival coordinator three weeks prior to <br /> this event. <br /> 14. completed by: Solo Business Owner 9/9/2024 <br /> Signature Title Date <br /> &20 Gat. <br /> Health Permijil Handwash Waler <br /> Slerno wlChefFnq <br /> R!h _ Papor HeM7axals <br /> Soap drspenaer <br /> d'�Boatd SoniMw bucket- <br /> bleach a Wolof for <br /> Propane Sto weach s nQ wlFlr+��o <br /> Booth must be on <br /> _ Concrete,Asphalt, <br /> Piyti'rood,or a Tarp. <br /> Propane Ton.'t — .. _ - ... <br /> Soap end Water Wnse Water 9leach and Wetcr Garbage <br /> Can <br /> Flls EMtllquisher <br /> foxaa <br /> ICe Cooler oNa!the grpuntlr <br /> 5Gol H&,d wash <br /> d Food confa7amwfb Waslowalercontaln orEM.... <br /> -0 <br /> 1868 E. Hazelton Avenue I Stockton,Californla 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br /> EHO 18•02 Page 9 of 11 TEMP EVENT APP <br /> 0713117 <br />