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SAN ,JOAQUIN Environmental Health Department <br /> - C 00 I\I I Y <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45a17(if food is used the following day,maintain below 41°F temperature): <br /> ,...,� ,'tests ❑Refrigerator <br /> L21 etrigerated truck Ice bath and tu <br /> El Other(specify) 0(� T"at <br /> 11. 1 anljx,60iding the following iterns within my booth for the sanitary cleaning of food preparation utensil <br /> hree compartment sink. <br /> OR <br /> ..roe 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 /> .�drer supply dispenser with warm water at a minimum of 100aF(i.e.5-20 gallon container with spigot). <br /> a separate tub(bucket or basin)for the collection of rinse/wastewater, <br /> _,,cr towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hougi of ope��ee�ion: <br /> HI7✓Cre ,.re e.�rt'ark` <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. q <br /> 14. Completed by: ew'i'G'� -I— L ~ Z <br /> Signature Title Date <br /> Health Permit A Mend wnan Wamr <br /> 51oma wlChattinp <br /> Dlan <br /> Paper Hand iawak <br /> Soap Alspaneor <br /> Gtlunp Finartl Snnllhm ho <br /> I. <br /> of to A walaf t <br /> Propane Slova <br /> alaaGl aionng wiping Gears <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood.or a Tarp. <br /> Propane Tart: _.._' <br /> Snap aM Walm I,Into Walel rgeaGl and WAW I <br /> GDrb0g0 <br /> Can <br /> � Fko rzllrqulNwr <br /> nz-,.., <br /> Ice Gooier l I — br;aiHandww, <br /> Fxua Ica bags 6 road conlalnara mwl no 11I Waelawolw Cadamr <br /> arorcd a rncuoa an al Me pmwrdl <br /> 1868 E.Hazelton Avenue I Stockton,California 9152061 T 209 468-34201 F 209 464-0138 1 www,sjcehd.com <br /> El Ip 10.02 Perin a nr 11 TEMP EVENT APP <br /> a RV17 <br /> WAlrfluill't;1' ia1,talIn!fill]11i)t1 .111117tuff 111:1A1+ 144�1?1" Iv� �$�;� ���ITurfir'T ourli `muffrI 3'W.qw '" <br />