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4/24/23,8:53 AM image0.jpeg <br /> rlt <br /> S A N 10 A Q U 1 N Environmental Health Department <br /> C, C?I_Ii1..,f ' ,, <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 /> Mhree 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 /> 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 /> ,,P—rrwater 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 persons to be present in booth during all hours of operation: <br /> pVN ,2 G .✓ <br /> cation in <br /> *"Important"* All food vendor booths are subject toof inspection. <br /> s checklist must )be in the booth at all llhours of <br /> preparation for this event. A copy <br /> preparation a eration. Return original to festival coordinator three weeksor to <br /> pri <br /> this event. D-�"J L"C-2 If Q >1Z 3 <br /> 14. Completed by: Signature Title Date <br /> 5.20 Gal. <br /> Hand wash Water <br /> Health Permit Sterno w/Chaffing paper Hantl Towels <br /> Dish <br /> Soap dispenser <br /> Sanidzer bucket- <br /> bleach 8 water Tor <br /> Cutting Boerd storing wiping cloths <br /> Bleach <br /> Propene Stove Booth must be a <br /> Concrete,Aspha <br /> Plywood,or a Ta <br /> Propane Tank " <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> + Extra <br /> a, �'k Water <br /> r'ae <br /> 5 Gel Hand wash <br /> Ice Cooler wastewater container <br /> Extra Ice Bags&Food containers must be <br /> stored 6 inches off of the ground! <br /> T 209 468-3420 ( F 209 464-0138 1 Www.sjgov.org/ehd <br /> TEMP EVENT AP <br /> 1868 E. Hazelton Avenue Stockton, California 9520ag1 8 of 11 <br /> EHD 18-02 - <br /> nR 11911% - <br /> https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/KtbxLrjNcfTMsLgKxQSPBgVfvpNJXvVIIB?projector=l 1/1 <br />