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S A N J O A Q U I N Environmental Health Department <br /> COUNTY <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 OF temperature): <br /> M Ice chests ❑ Refrigerator <br /> X Refrigerated truck ❑ Ice bath and tubs <br /> 0 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 /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate Band 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. N� s o responsiblet <br /> rso to be preseni:' oo durin all hou of operation: <br /> I <br /> **Important** All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this ev t, A copy of this checklist must be in the booth at all hours of <br /> preparation an operatl n. Return original to festival coordinator three weeks Prior to <br /> thi t. ' <br /> 14. Completed by: 7 1q _-2� <br /> Sig ure Title ate <br /> n <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Sterne wlChaffing <br /> Dish Paper Hand Towels <br /> :1Udp d15p•�n5�,' <br /> Cul[Ing Board Saniuzer bucket- <br /> bleach&water for <br /> Bleach <br /> staring wiping cloths <br /> Propane Stave <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse ater Bleach and Water Garbage <br /> Can <br /> Fire ExtlnOulsher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra fee Bags 8=Confulnets Wastewater Container <br /> stored 5 inches a <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06119119 <br />