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SANhJQAQUIN Environmental Health Department <br /> --COUNTY— <br /> Greatness gro,e•s 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 eF temperature): <br /> Ice chests ❑ Refrigerator <br /> Refrigerated truck ❑ Ice bath a tubs t <br /> ©Other(specify) Add <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). l <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 4 <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 1007(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 responsible persons to be present!rLbooth during all hours of operation: <br /> Aa k igAd �H e _ <br /> "Important" All food vendor booths are subject to inspection. Please matte 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. Re urn original to festival coordinator three weeks prior to <br /> this event. �, p , o ? <br /> 14. Completed by: �t �4Lht2� lql �/Jl2) <br /> Ignature Title Date <br /> -�a"44 <br /> 5-2a Gel. <br /> Health Permit Henri rash Wal•a <br /> stamp rlChaff r>g <br /> Paper Hare To..eis <br /> SOaP dapa^ear <br /> Gutanp BwrO Sanlbier lwc.-e1- <br /> h1ear 5 wa10r for <br /> Propane Slwe nb <br /> S1 g"^Poq dotha <br /> Booth must be on <br /> Concrete,Asphalt, <br /> '� Plywood,or a Tarp. <br /> —P end Wela R—Wer Bleach and water Garbage <br /> _. 9 <br /> Can <br /> Fln EAfnputhnr <br /> Exva <br /> Wa1ar <br /> Ice Cooler Ji 5CW Han rash <br /> E�fri Ice aaga d Fcwd CUnrakrarf musr bo W"te—ler Co Z—ar <br /> ■torod 6!r'sc1,•a mT of the proeeldl <br /> fl -------------- <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 j www.sjgov.org-ehd <br /> EHO 16-02 Page a of 11 TEMP£VENT'APP <br /> Owls119 <br />