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{,s elk SKJ OAQ.0 I.N (Environmental Health Department <br /> COUNTY <br /> U N <br /> `, ':fir•' y. ^.... <br /> N� 1. <br /> ; � Gi•a~cr'nes~; grows ftrc: <br /> 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 aF temperature): <br /> fqIce chests ❑ Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> t 1. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> C Three compartment sink. <br /> OR <br /> P 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 /> 0 Detergent, bleach, and wiping cloths(cleaning towe(s). <br /> [J 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 ray <br /> booth: <br /> ,9 Water supply dispenser with warm water at a minimum or 1007(i.e, 5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of dnsehnrastewater, <br /> ❑ Paper towels and uuElk-style sawosawo container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> z <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 woeks Vrior to <br /> this event. <br /> 14. Completed by: <br /> Signat�r Title Da e I <br /> 5v20 CK <br /> Health Perm <br /> Limwandwafh%%I r <br /> lame wlCts.H�rq <br /> Ulm <br /> Fapar Herx1 Trnwh <br /> Sanp diaponser <br /> CuntnQ 6onrd <br /> SagWzar AUCkaI- <br /> Propana Glove lAaanl i water for <br /> 91�prh COMO WOrla doff <br /> Booth must ba on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> :', SuP ena Wolar Rlnm Wets! Dlearh W Wa;w <br /> Garbage <br /> rve l at4yultlwr Can <br /> Ice Cooler - 6 Gal Hvwwash <br /> Edda kb Dogs 6 Food contunars muff Da WaftfwNla Cpneahp <br /> sbrod E lAchos ollolfno�aundl <br /> 1868 S. Hazelton Avenue J Stockton, California 95205 J T 209�466-34201 F 209 464-0138 J www.sjcehd.com <br /> 0713117 c'! Papa 6 of 11 <br /> TEMP EYENTgpP <br />