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4/26/23, 12:30 PM 20230426_120724.jpg Ask <br /> S Q N J QQ 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 focal is used the following day,maintain below 41"F temperature): <br /> Ice chests XRefrige-.rator <br /> ❑Refrigerated truck El Ire bath and tubs <br /> Other(specify). . . . <br /> 11. I m providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR Three compartment sink. <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 /> (J 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 soaQ container. loi7rk�'iWJ4'5r? 'sv� "-) Ira,'1,' - <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> L l i�✓/.L_ �/�/�✓i'Z�i���, �S;cGarLC"' ��t''t'�tr�' <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 <br /> 14. Completed by: <br /> i nature +� 3 <br /> 9 Title Date <br /> Health Permit Ha n(wean wei", <br /> S(e+no wic„amng <br /> o,a(, <br /> PS{Wr KiMI P>,"bts <br /> S"eP Oispenaw <br /> ��Bsuro atne:w th:ekeo <br /> bl,A—, hx <br /> Propane 9we Ifleati, _ ,Kny w¢,.y,lxnr <br /> Booth must be on <br /> Ckille le,Asphalt, <br /> 8. P; ",or a Tarp. <br /> Pro—Tank <br /> , �," t watWria PonsaWPW Blbad,laNaWalw I Garbage <br /> Can <br /> re9 EwnpWOhw <br /> [MI <br /> WWbI <br /> Ice Cooler „ <br /> 1, Ex"ke sags 6 FWd COnMWWX font be wnie"ter conUanar <br /> ...___.._._�.._.........____.. M—d 6 Ytc„sa oKof eN gm.W <br /> 1868 E. Hazeiton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.smov.oro/ehd <br /> https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/QgrcJHrjCsBXLNTStWXBtSVngMCwFMIcGwb?projector=1&messagePartld=0.1 1/1 <br />