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SAN J OAQ U I N Environmental Health Department <br /> ,,- JUNTY <br /> 10. 1 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 /> Q Ice chests ❑ Refrigerator <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 /> [] 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 towels). <br /> [fl"Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate hand wash'ng 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 /> 0 One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Names of responsible p rs ns to be present in booth during all hours of operation: <br /> "Important" All food vendor bboths are s bject 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 a t. r , <br /> 14. Completed by: 1 <br /> Signature Title Dallte <br /> 5-20 Gal. <br /> --Health Permit Hand wash Water <br /> Sterno wlChatfing <br /> thsh <br /> Paper Hand Towe s <br /> Soap dispenser <br /> Cutting Board —� ( sanit¢er b..cket <br /> t I _ bleach&wale-fi r <br /> Propane Slove <br /> !i nuu <br /> storingw�prtg •ths <br /> r- <br /> Booth must be on <br /> 11 n ; Concrete,Aspha t <br /> }— 0 Plywood or a Tarp <br /> Propane Tank -- <br /> soap and Water Rinse water ( Bleach and Water Garbage <br /> � _' <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Wafer <br /> Ice Cooler 5 Gal Rand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> – – stored 6 inches off or the ground' <br /> �J <br /> 1868 E Hazelton Avenue I Stockton California 95205 1 T 209 468-3420 1 F 209 454-0138 1 www.sjcelld crr <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> n7rv17 <br />