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N j A QUIN Environmental Health Department <br /> C_G iv i '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 /> X[jce chests ❑ Refrigerator <br /> /❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items vyitthin 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 /> r <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> 7ne separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> Paper .towels and pump-style soap container. <br /> i <br /> 13. Names`responsible persons to be present in booth during I urs of operation: <br /> vV -R e e 2 rn11 <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 /> s e nt. ' - <br /> 14. Completed by: ��'r�'L— ��� <br /> Signature Title D' ate <br /> 5.20 Gal. <br /> Health Permit Hand wash Walar <br /> �temn w;ChaMng <br /> Dish <br /> Paper Hand Towels <br /> SUaD d5penser <br /> C u!L—,Bnarn Sani ar t- <br /> � l 1 bleachh awaterat-'or <br /> Bleach stonng wiping ck:ths <br /> Propane Stove 1` 1 <br /> Booth must be on <br /> O Concrete,Asphalt. <br /> Plywood,or a Tarp. <br /> Propane'ant <br /> Soap and Water Rmse Watar 3leach and Water <br /> Garbage <br /> Can <br /> Fire Exnngwsher <br /> E.tre <br /> Ice Cooler 5 Gal Hand wash <br /> EAv Ice Bags 6 Food Contains,s must be Wastewater Container <br /> scored 6 inches o7of fhe ground$ J <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 07/01/2025 <br />