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S A N 10A Q U I N Environmental Health Department <br /> _ i . - - <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) prepackaged n/a <br /> 11. I 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. <br /> 12. 1 am providing the following for adequate hand washing facilitles, but separate from utensil wash within my <br /> booth: <br /> 0 Water supply dispenser with warm water at a minimum of 10001F (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 in booth during all hours of operation: <br /> Antoinette Hill, Darren Hill <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 festival coot to othree to <br /> this event. <br /> 14. Completed by: _ Owner 6/11/2024 <br /> Signature - Title Date <br /> 5-20 Gal <br /> Health Permit St Hand wash Water <br /> errno rMChsRirnq <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cuthnq Board San-we'huckel. <br /> bl each tt v rnr for <br /> Rnlune flare Bleach storeng nrping Laths <br /> Booth must be on <br /> Concrete.Asphalt, <br /> Ptywwd,or a Tarp. <br /> P+avano rank <br /> Soap aM Water Rtnm aler Bleach and Wata Garbage <br /> Can <br /> Fire Exhnpnssher <br /> n6rera <br /> Weta <br /> FIceooler 5 Gal Hand%rash <br /> Exfa roe Saga d Food ContaNmrs rnnst be Waskewater Cantwor <br /> arared 6 nchee off of the Wound? <br /> 1868 E. Hazetton Avenue I Stockton, Califomia 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 1"2 ?age B of 11 TEMP EVENT APP <br /> OB/191i9 <br /> r <br />