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t <br /> S A N!J OQ Q U I N Environmental Health Department <br /> ' I am providing the following cold temperature control for the cc'd holding of potentially hazardous foods below <br /> 45 F :If food is used the following day, maintain below 41-F temperature) <br /> 0 Ice chests ❑ Refrigerator <br /> Refrigerated truck #".�Ice bath and tubs <br /> Other(specify) - <br /> I am providinq the following items within my booth for the sanrftary cleaning of food preparatror 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 c each <br /> solution {one tab`--spoon of bleach per gallon of water) <br /> Detergent, bleach. and wiping cloths(cleaning towels) <br /> Tt:b to store wiping cloths In bleach solution <br /> I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> boot^ <br /> r'AVjater supply dispenser with warm water at a minimum of 100'F(i e. 5-20 gallon corta:rer r iM sp gct� <br /> One separate tub(bucket or basin)for the collection of nnsewastewater <br /> Paper towels and pump-style soap container <br /> Nantes of responsible persons to be present in booth dunng all hours of operation <br /> "Important" All food Vendor booths are subject to lnspdcton Please mace a spy cf trs app:ca'ton :n <br /> preparation for this event A copy of this checklist must be in the at all hours of <br /> preparation and operation. Retum original to festival coordinator three weeks prior to <br /> this eve <br /> t< Completed by .�� , r - _ ( �,L;+'ti?Y � '" <br /> Signature '- Title Date <br /> wx� <br /> Health Permit <br /> ',xvv•xswrw. i ' <br /> r trwraA�.auv ks <br /> Bool''r't::5t be or, i <br /> Concrete Aspha 4 I <br /> PiptooC of a Tarp <br /> «.......� -..a:. ��. ,ro..... <br /> Lxu>rsge <br /> Can <br /> rs•.� <br /> Ice Cooler <br /> !yin kw&agf 6/-ooq S.crrRwr+a rt"Os Nwter.fr r:yssra <br /> - roknarJ tf F+cf+ea t✓1 id the$rc.,nS <br /> ?868E Haze ton Avenue ( Stockton. California 95205 il T 209 468 3420 ; F 209 464-0138 www sigov or;.ehd <br /> I lit)1"2 1'47t R t4 t t t I Ado'i'.1 N r AN' <br /> C-0.r19.'301:! <br />