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SAN JOAQUIN Environmental Health Department <br /> Cr,U �-!_ ., <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 /> ,❑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 /> ❑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 /> "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. Retum original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: <br /> Signature Title Date <br /> 5-20 Gal <br /> Health Permit nand rest wamr <br /> Sk r acnamrg <br /> r <br /> PaPBr Florio TOwetS <br /> Soap�1sa <br /> Ctdbrq Board sa"rtrrer WdcaS- <br /> tdeadc 8 water for <br /> Pol>any Stove `-�a�9�1»9��' <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Beads <br /> b 0 '_Z�li <br /> Plywood,or a Tarp. <br /> r-}op�ce Tads <br /> -.1 water Brae wakw Brad,aria water Garbage <br /> Carl <br /> Foe rat>gmsher <br /> Fora <br /> Wsty <br /> Ice Cooler 5 Gal fiord mrsh <br /> Farrar k e Bays d Food ConG.vs av&he wasamade"carder <br /> Varea 6 oxhas off of tf e g o."d+ <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov org/ehd <br /> EHD 1"2 Page 6 of 11 TEMP EVENT APP <br /> 06119119 <br />