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1 , <br /> A -.-300,-.0 Environmental Health Department <br /> 10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457 (if food is used the following day, maintain below 41'F temperature): <br /> (<chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11, I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> �i deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> sol on(one tablespoon of bleach per gallon of water). <br /> rgent, 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 facifties, but separate from utensil wash within my <br /> booth: <br /> Ater supply dispenser with warm water at a minimum of 100°F(Le, 5-20 gallon container with spiget). <br /> One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> Paper towels and pumL)- tWe soar)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. 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 nd.operaflom Return 9.dginal to festival coordinator three weeks prior to <br /> this ev <br /> 14. Completed by: <br /> cj4ek <br /> ig natu re Title Date <br /> sza oil. <br /> Health Permit Hendweahwetar <br /> sterna wm�rrng <br /> Paper HarW raxels <br /> Dkh <br /> Soap d'spenev <br /> C 1dng 8aan1 <br /> Sanfter 6udcel- <br /> t•Barb&W-Aterior <br /> Propene Stave Bleach shoring wiping doths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp, <br /> Propant Tank <br /> L soap and Wale Rice VJatar Bleach and water Garbage <br /> Fu.F_xtirsguiBrrer <br /> Can <br /> - Eztry <br /> or <br /> 4Jeter <br /> Ice Cooler 5 GM Handwreatr <br /> Fxda ke Begs a Food CDntM"m must be Wagew-alar Container <br /> efored t7 L7Gres ail d Nre ground! <br /> 1868 E. Hazelton Avenue E Stockton, Caiifomia 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EHD 1"2 Page B ai 11 <br /> 07W7 TEMP EVENTAPP <br />