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r <br /> S Q N J QA Q u I N Environmental Health Department <br /> �o ' COUN i Y--- <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 /> ❑E- Refrigerated truck ❑ Ice bath and tubs <br /> 0 Other(specify} <br /> 11. 1 am providing the following items within My booth for the sanitar)(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 /> N12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> M Water supply dispenser with warm water at a minimum of 100'F(i.e. 5-20 gallon container with spigot). <br /> 0 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 /> *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 inai to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: ��iF1rf�t�►(tif1 1� <br /> Signature Title Date <br /> s4_MM*&'. .�€ - 5.20 Gal. <br /> Health Permit I land wash Water <br /> SleFm wlChaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap d#spenser <br /> CuFting Board $anilizer 4uckel- <br /> blench&.water fur <br /> sturing wiping Goths <br /> Propane Stove Bleach <br /> Booth most be on <br /> 0 Concrete,Asphalt, . <br /> Plywood,or a Tarp. <br /> a" <br /> ;l <br /> Propane Tank <br /> �Mr <br /> RinsueWer 9leachandWaterGarbage <br /> Can <br /> Fire E:xlaigu <br /> F�ctra <br /> Water <br /> Ice Cooler fr, l::r -^-, �7� <br /> e^' 5 Gel Hand wash <br /> F Fxlra foe Bags&Foo Wastewater Container <br /> -------!'` sforad6inchesaf7ol <br /> 1868 E. Hazelton Avenue E 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 /> 06119f19 <br />