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i <br /> S A N J A Q U N Environmental Health Department <br /> COUNTY <br /> Greatn,ss grows here, <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the following day,maintain below 41°F temperature): <br /> ® Ice chests ❑Refrigerator <br /> ❑ Refrigerated truck ®ice bath and tuba <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 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 rinsetwastewater. <br /> ®Paper towels and pump-style soap container. <br /> I <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Linh Ha <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. Retum original to festival coordinator three weeks prior to <br /> this eveaL <br /> 14. Completed by: Manager 9/5/19 <br /> ig ature Title Date <br /> 6-10 wi. <br /> Health Permit fund w%h webr <br /> st.,ne wrctwrmy <br /> nen <br /> Paper Hind rese6 <br /> soap c> u. <br /> CuttNy7 f3nerrt SarJtize hur*at- <br /> blench&wvtcr for <br /> Propene stove trtaedi aWng WODW cloths <br /> Booth must be on <br /> Concrete.Asphalt. <br /> Plywood,or a Tarp. <br /> Propane Tank r..-. ......_, ..a.... ..�_ .._.. .. <br /> soap er,d wMer nt,.e water Garbage <br /> fire bdirrtlydsher Can <br /> Frta <br /> � Wn1nr <br /> Ice Cooler GGal lined wash <br /> Fx"lea aepsdf'ood Containers must be weslaweier Container <br /> skyo 6lncho2 oR&the pruundl <br /> 1868 F. Hazelton Avenue j Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> Ff ID 16-02 Page B of 11 TEMP EVENT APP <br /> 07rJ117 <br />