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SA N J 0 A Q U I N Environmental Health Department <br /> --COUNT Y <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 41'F temperature): <br /> ❑ Ice chests VRefrigerator <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 /> E/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-style soap container- <br /> 13. Names ponsible persons to be present in booth during all hours of operation: <br /> I , <br /> fl <br /> —Important'" All food vend booths are subject to inspection. Please make a copy of this application in <br /> preparation f this event. A copy of this checklist must be in the booth at all hours of <br /> preparatto a d operation. Return original to festival coordinator three weeks prior to <br /> this a nt. . <br /> 14, Completed by: r1�R+ 44 _ 16, <br /> ignature Title Me <br /> o-zu Gal. <br /> Health Permit r' Handwash Water <br /> Stemo w/Chafring <br /> Dish <br /> Paper Hantl Towels <br /> Soap dispenser <br /> Cutting Board <br /> Saritizer bucket- <br /> bleach 8 water for <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> _ Concrete,Asphalt, <br /> ` PI ood,or a Ta <br /> Propane Tank <br /> AW Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Fire Extinguisher <br /> Can <br /> F�ctra <br /> water <br /> rice Cooler 5 Gal Hand wash <br /> Extra Ice Sags d Food Containers must be Wastewater Container <br /> -- " stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www,sjcehd.com <br /> EHD 16-02 Page 8 of 11 0713/17 TEMP EVENT APP <br />