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S A NJ o A Q U I N Environmental Health Department <br /> ----COUNTY-- <br /> ;;r.; (;rrrilness t/lows ltr l'r. <br /> 10, 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45OF(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. 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 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 /> ER One separate tub(bucket or basin)for the collection of rinse/Wastewater. <br /> U Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <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 /> 14. <br /> this event. Co Owner 9/18/2024 <br /> Completed by: <br /> Signature Title Date <br /> 5.2a Gal, <br /> Health Permit Handvrashwalar <br /> Memo wlCharlmg <br /> J11h <br /> Paper Hand Towels <br /> Soap tl�spenser <br /> Golfing Soard Sarr'axer bucket- <br /> bleach 6 water for <br /> Propane sta�a Bleach srodny wiping doge <br /> Booth must be on <br /> _ _ Concrete,Asphalt, <br /> _ P{Wlood,or a Tarp. <br /> PropaneTe <br /> Soap and Waver Rinse water Bleach end Water Garbage <br /> r <br /> - Fire FxhrlgUlsher Can <br /> - Extra <br /> Water <br /> ICe Cooler 6 Gal Handwash <br /> Exim Ace Baps 6 Food Confahfers mustba Wastewater Contalner <br /> scored 6Inches aYol the prWndi <br /> 1868 E. Hazalton Avenue I Stockton, California 95205 1 T 209 468-3420 j F 209 464-0138 l www,sjcehd.com <br /> EHD 16-02 Page a of 11 7WP EVENT APP <br /> 0713117 <br />