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SAN,-JOAQUIN Environmental Health Department <br /> c .(—,! II.: TY <br /> 10. I 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 R 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 dispenserwith 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. Piease 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 /> his event. <br /> 14. Completed by: 2-1 klG' UL� <br /> Signature Title Date <br /> s.2o-oar. <br /> Hard waoh WaErr <br /> Health Permlt Stemo wlChallrQ <br /> ITsh Paper Hartl Taweli <br /> Soap tlispertsar <br /> SaMrzer bucks. <br /> Cs.'tgng Beard bleach&v alcr!or <br /> slonng-ping dalhs <br /> Blanch <br /> Prpa^e Suva <br /> Booth must be on <br /> concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> I <br /> w raGarr.rank <br /> 5cap and ater hater RIORL11 aNJ WOW Garbage <br /> Can <br /> �ra Fytlnquslur <br /> cYtla <br /> Water <br /> Ice Cooler 5Gal Hoed wash <br /> { F1rra Ice Bads b Food Containers must be Weslewaler Conlarrer <br /> .--— stored 6 Incaes a of the ground! <br /> 1858 E. Hazetton Avenue 1 Stockton, Cialiforn>a 95205 1 T 200 468-3420 } F 209 464-0138 1 wWvv sigov org/ehdAPP <br /> t6-02 Page 5 or 11 <br /> TEMP EVENT0605119 <br />