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A N ,O A Q U !N Environmental Health Department <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) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. a <br /> OR <br /> Q 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 /> 1%n Water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> 16 One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> Paper towels and puma-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. &9turn original to festival coordinator <br /> 14. Completed by: *F c <br /> Signature Title Dat <br /> 6.20 Gel. <br /> Health i�ermit Hw4 wash water <br /> Slamo w/Chaffft <br /> Dah Paper Hand Towels <br /> Swp dapanaer <br /> Ctlt0np Board Satrlizsr b+achet- <br /> bMadt&water far <br /> Propane Stove Bleach <br /> Booth rwal be on <br /> Concrete,Asphalt. <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soep and Weter Rlnsa Water Bleach and water Garbage <br /> Can <br /> Fire EAngWsher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal HandWash <br /> Extra Ice Begs&Food Containers must be Waelewater Cantener <br /> stoled 6!elites of or O&g NUMP F -1868 E. Hazelton Avenue I Stockton, California 952051 T 209 466-3420 F 209 464-0138 1 www,sjcehd.com <br /> EHD 16-02 Page D o111 TEMP EVENT APP <br /> 0713117 <br />