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S A N D QA Q U I 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. dam 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 /> lution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Eff Tub to store wiping cloths in bleach solution. <br /> 12. I 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 /> 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 p sons to b pr t in boot uric all hours of operation: <br /> .- � �en-u& <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 /> this event. <br /> 14. Completed by: tirk( � _s AI/112112 <br /> Signature Title Date <br /> 5-20 Gat <br /> Health Pe L <br /> Hand:;•ash';'.ater <br /> Sterno•::;Chaffino <br /> Dish <br /> Pape*!`and TG':;a_Ig <br /> Soao dispenser <br /> Cuttmq Board Saaiti_er bucket- <br /> "'l-aa*S:rater for <br /> Propane Stone Bleach storfrnq,;a^ping cloths <br /> Booth must be on <br /> Concrete Asphalt. <br /> •s... Plywood.or a Tarp. <br /> Propane Tank <br /> Soap and'-Hater Rinse 1%rater Bleach nd',later Garbage <br /> Can <br /> Fire Extinguisher <br /> ExtPa <br /> •;i atef <br /> Ice Cooler t 5 Gal Hand:vash <br /> cxt a!se Macs must:e :taste:eater Container <br /> Stored F. : .^e <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ( F 209 464-0138 ; www.sjgov.org/ehd <br /> EHO 16-02 Paae B of 11 <br /> 06 29 2o2S TEMP EVENT APR,, <br />