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SA Nt"JOAQUIN e <br /> --^,. —COUNTY- <br /> EnVir®nmental Health Department <br /> '''�rr•nt ='' �., e,�t.11uss y,ul;s lll:rt, <br /> 10- I 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 <br /> [P temperature): <br /> ree chests <br /> ❑Refrigerator <br /> ❑Refrigerated truck <br /> ❑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 <br /> ❑Three compartment sink. utensil <br /> OR <br /> lfhree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsi <br /> solution (one tablespoon of bleach per gallon of water). ng and one for a bleach <br /> ❑Detergent, bleach,and wiping cloths(cleaning towels). <br /> ❑Tub to store wiping cloths In bleach solution. <br /> 12. lam providing the separate from following for adequate hand washing facilities but <br /> booth: m utensil wash within my <br /> R Water supply dispenser with warm water at a minimum of 100eF(i.e.5-20 gallon containe <br /> r with spigot). <br /> P< e separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-stvie soap container. <br /> 13. Names of responsible persons to be presen in booth during all hours of operation: <br /> s <br /> "Important*" All food vendor booths are subject to inspection. Please make a copy of this a lication <br /> Preparation for this event. A copy of this checklist must be In the booth at all hours of <br /> Preparation and operation. R®turn orlpinal to festival coot 1 a or three week�a nrrnr F.. <br /> this® nt. <br /> 14. Completed by: <br /> Sign ----____ --�'�r1C✓ t7— / $— / 7, <br /> q �,�5 Tltie Date <br /> Health Perml szo Clot, <br /> stemo wlchemng Hand wash Water <br /> Dian <br /> Soap dlspeneer ►'spar Hend Towels <br /> Culling Beard <br /> Propane Stove Senitizer buckel- <br /> aloaah blaaah$water for <br /> etodng wiping ololhe <br /> /', Booth must be on <br /> •rr , , ,', --0 Conorete,Aephett, <br /> Propane Tank -, �,�' Plywood,or a Tarp. <br /> Soap and Water Rinse Water <br /> 4leeah and Water <br /> Fire Garbage Extinguisher Can <br /> Extra <br /> Water <br /> Ice Cooler <br /> - �- ,_. ., cxrre rco vxps s reed canro,n�ra mw16o Wna owatnr eontolnar stared a Poehes oil of fho ground/ <br /> 1868 E. Hazelton Avenue Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br /> EHD 18-02 <br /> 0713117 Page 8 of 11 <br /> TEMP EVENT APP <br />