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S A N J 0 A O Lj i N Environmental Heafth Department <br /> Cuulti <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 0 Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I am 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 /> 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 /> ®Water supply dispenser with warm water at a minimum of 100`F (i,e. 5-20 gallon container with spigot). <br /> ® *ne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ® Paper towels and pump-style soap container. <br /> 13. Names of resp n ible e o s to be present in booth during all hours of operation: <br /> L setae Vasquez <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 even <br /> 14. Completed by: �� _ Owner 04/10/2023 <br /> Signature Title Date <br /> 5-2a cal. <br /> Health Permit [-1, <br /> Hand wash Water <br /> =-IChafflng <br /> Paper Hand Tawals <br /> Soap dlspedser <br /> Cutting Board <br /> Senitlzer buckol- <br /> bleach&water for <br /> Propane 9tova Bleach storing wiping cloths <br /> Booth must be on <br /> I� Concrete,Asphalt, <br /> Q ,N, Plywood,or a Tarp. <br /> Propano Tank _�.�-. , 1.; c+l�•�i !tiev: <br /> r -r- Soap and Water Rlnse Water Bleach and Water <br /> Garbage <br /> Fire F_xt#rnguisher Can <br /> Extra <br /> water <br /> Ice Cooler <br /> 6 Gal Hand wash <br /> it Extrg lee Begs d Food Conlahrers must be Wastewater Coetalner <br /> Voted 6Inches v/rof the groundl <br /> 1868 F. Hazelton Avenue; ( Stockton, California 95205 � T 209 468-3420 � F 209 464 U13t3 1 www.sjgov.t�rcl/ehd <br /> 06119)19 <br /> EHD 16-02 Page S of 11 <br /> TEMP EVENT APP <br />