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S A N J O A Q U I N Environmental Health Department <br /> !.! .----COUNTY-- <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 41eF temperature): <br /> ❑ Ice chests �EfRefrigerator <br /> Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. 1 m 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-stVle soap container. <br /> 13, Names o 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. Return original to festival coordinator three weeks prior to <br /> this event. _ <br /> 14. Completed by: �U IMl1 uc' 7 UJ rl e— Y 0 S—a S <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Sie Maud wash wale` <br /> mp w1Cha!Iing <br /> Dish <br /> Paper Hand Towels <br /> Saco dspensat <br /> CutSing Board SOMIzbr bucket- <br /> bteach 8 waler for <br /> Propane Stove Bleach staring wiping cloths <br /> Booth must be on <br /> Concrete.Asphalt, <br /> Plywood,or a Tarp. <br /> Soap end Water Rinse Water Bleach antl water <br /> Garbage <br /> Can <br /> Fire Exlinguisher <br /> Extra <br /> Walar <br /> Ice Cooler 5 Gal Mard wneh <br /> Extra Ice Bags d Food Containers must be Wastewaler Contelner <br /> stored 6 inches eff orthe ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205E T 209 468-3420 F 209 464-0138 1 www,sjgov.org/ehd <br /> EHO 16-02 Page 8011 TEMP EVENT APP <br /> 06118!1 B <br />