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� ! Environmental Health Department <br /> 0 U N'Y--- <br /> UA <br /> J jf0. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> J / 45'F(if food is used the following day,maintain below 41'F temperature)_ <br /> ❑ Ice chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(speci)() <br /> 11_ I 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 rinselwastewater. <br /> ❑Paper towels and pump-style soap container- <br /> 13. Names of responsib,lle�persons 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 event_ ` <br /> 14. Completed by. a,l.'W&' 0-9�� <br /> Signature Title -Date <br /> Health Permit =i Hand wwash20 Water <br /> strlrto w Chafing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> cuttingBoard <br /> Sambzer bucicet- <br /> bleach 3 crater for <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt <br /> on e, p >; <br /> Plywood,or a Tarp- <br /> Propane <br /> soap and Wa&s Fattse Water Bleach and Water <br /> Garbage <br /> Fve Ether Can <br /> Water <br /> Ice Cooler ,- 5 Gal Hand wash <br /> Extra!ae Bags a Food Comers masrbe Wastewater container <br /> Sbred6b?chesoBoffhegroratd7 <br /> 1868 E. Hazelton Avenue {EHa,s-0z Stockton, Oalifomia 952051 T 209 468-3420 { F 209 46d-0138 { 1vuw.s1cehd_com <br /> AT."km-r Page 8 of l l �•�..,,r... ..r <br />