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S A N J U A Q U I N Environmental Health Department <br /> 10. l 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 /> 99 Ice chests Refrigerator <br /> ❑ Refrigerated truck $t 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 /> 2 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 /> �f 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 resporisibl persons to be present in booth during all hours of operation: <br /> Mishael Moran <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 event. <br /> 14. Completed by Mishael Moran Owner 1/3/2023 <br /> Signature Title Date <br /> ' ..a•� .jai <br /> Health Permit rang xasn'; <br /> L•ST <br /> �dtl=r�[dnC T�wC15 <br /> :•,IanG 3oael Senlllzar 7,.[ae r• <br /> a:eacn G water for <br /> srnnngwsyng 70tPs <br /> �r::rar.e S:c:e ti'ext <br /> Booth must be on <br /> Concrete.Asphalt <br /> OPlywood.or a Tarp <br /> Garbage <br /> Can <br /> Fvg cmrtpmaner <br /> =x[rn <br /> •NdIR^ <br /> Ice Cooler 5Ga:^falc wash <br /> c r:ra ke Bags d 10v::7n,a,raa n 'Naetewitlr Canra.ler <br /> s(nrea B w,heS n1f�1:ne <br /> 1368 E Hazalton A,,er 1ue ; Stockton California 9a205 ; T 209 468-3420 1 F 209 46 4-0138 1 www slcehd com <br /> EHD 16.02 Page a of t I TEMP EVENT APP <br /> 07;3117 <br />