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SAN J O A Q U I N Environmental Health Department <br />C0L)�1TY <br />10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4 °F (if food is used the following day maintain below 41 °F temperature): <br />Ice chests Vefrigerator <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 />[�hree 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 />solu n (one tablespoon of bleach per gallon of water). <br />etergent, 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 />5d"Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />2110ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />5Gaper towels and pump -style soap container. <br />13. Names of reFnsibl7_.,pWons 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 and operation. Return original to festival coordinator three weeks prior to <br />this ev nt <br />14. Completed by: `7 -, 3 -18 <br />Signat S �o _ Date <br />P 5-20 Gal. <br />Health Permit P <br />Hand wash Water <br />Sterno w/Chaffing <br />Dish <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board Sanitize' bucket - <br />bleach & water for <br />Propane Stove Bleach storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Propane Tank <br />Soap and Water Rinse Water Bleach and Water Garbage <br />Can <br />Fire Extinguisher <br />Extra <br />Water <br />Ice Cooler 5Gal Hand wash <br />Extra toe Bags & Food Containers must be Wastewater Container <br />- - --- stored 6 inches off of the ground! <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />