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r <br /> nei <br /> -i 0. 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 0 Refrigerator <br /> ❑Refrigerated truck et, ce bath and tubs <br /> Q'Other(specify) <br /> 11. I am providing the following items within my booth fbr the sanitary cleaning of food preparation utensil <br /> [.]Three compartment sink. <br /> OR <br /> tEr Three deep tubs (basins 6-8 iinches minimum), Mle for soapy water, one fcT rinsing and one for a bleach <br /> solution(one tablespae;t of blew;per galls.-i of;ter)- <br /> Detergent,bleach,and wiping cloths(cleaning towels). <br /> [-j Tub to store wiping cloths in bleach soiution- <br /> 11. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ErWater supply dispenser with warm water at a minimum of 100aF(i.e.5-20 gallon container with spiaot). <br /> a One separate tub(bucket or basin)for the collection of rinsee/wastewater. <br /> 'Paper towels and pump-style soap container- <br /> 13. dames of responsible persons to be present in booth during all hours of eration: <br /> ]41, <br /> IR <br /> —Important" I 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 op tion. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: i�j, t 73,..t- � -,3 <br /> Signature bat <br /> 5-20 GO. <br /> Health Permit r'.ami 2hYlaer <br /> st=._rsw ivlChaSsg <br /> Dish <br /> Para riad Tc++=..s <br /> Cutffnq Board . <br /> SanitEe:Wc&et- <br /> ' bleach a mfor for <br /> Propane Stave <br /> 1 '�cn s'aag r.�ciaths <br /> Booth must be an <br /> Concrete,Asphalt, <br /> - Ryv oad,or a Tarp. <br /> Propane ipnh ?' >aw�.. <br /> S p arm Wait. ar.a Water stead WBrK <br /> Garbage <br /> Frye ExfinAvisher C,Zri <br /> Fxtra <br /> lYaYr <br /> -----------I--------- <br /> Ice Cooler <br /> Ertra5 Gal hand wash <br /> SUrTd� naat�' 49zSW%Z--der <br /> 18 18 68 E. Hazelton Avenue j Stockton, California 95205 j T 209 488-3420 j r= 209 464-0138 j www,sjcehd.cam <br /> 16 02 <br /> 6617 Page 8 of 11 <br /> TEMP FVFNT GPO <br />