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SA N 10AQ U i N Environmental Health Department <br /> --C CCU NTY <br /> 10. 1 arl providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 5°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 /> ❑ D0[ergent, bleach, and wiping cloths (cleaning towels). <br /> ub 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 /> Z'�`aper towels and pump-style soap container. <br /> 13. �of relp4nsible Q.pe sOns to be present in bo during Fours oper tiq{i: prwor(b <br /> O <br /> GG�r J I ''! �J <br /> c` 1 . 4 J <br /> **Important** All food vendor bo t;s re subject to inspectio , Please make 9 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 prioir to <br /> this event., <br /> Jl <br /> 14. Completed by: r4 � <br /> Signature Title Date <br /> 5.20 Gai. <br /> Health Permit EHand wash Water <br /> Stemo wlChalfing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitizer budtel- <br /> bleach&water for <br /> Propane Stove <br /> Bleach storing wiping doths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tale. <br /> LM <br /> ProfaneTank - ----'-- �- ----- --- --��_ _..-. -- ...__._. . .. <br /> ,� Soap and Water Rinse Wator Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ire 83gs&Food Containers must be Wastewater Container <br /> stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue l Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www,sjrehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713/17 <br />