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r'A-1i �rrSD1 <br /> SQNJQQQQIN Environmental Health Department <br /> --COUNTY <br /> Greatness grows here. <br /> 10. 1 am providing the tollowing gold temperature control for the cold holding of potentially hazardous foods below <br /> 45°F(it food is used the following day,maintain below 41°F temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck [v Ice bath and tubs <br /> [v7Other(specify) CojA LJL& w - <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil f� <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 /> Deiegwd,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 nnsetwastewater. <br /> [Paper towels and pump-jbft soap container, <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> eiar�-t1�N J dAWMV-JS K<vi-i <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 festfval coordinator three weeks prior to <br /> tbf eve <br /> 14. Completed by: D Vj N2-- 3 f 3 rr <br /> S nature Title bate <br /> ssa QWr <br /> Health Permit K"WW1h WOW <br /> wrCtodt<p <br /> pan <br /> PeP'er Hand Tower <br /> w d+www <br /> CaAp Boutl SM&MV budW- <br /> p,rprt Sore 61.erh �'G-Ory doom <br /> Booth must be on <br /> concrete,asphalt, <br /> Prywmood,or a Tarp. <br /> vrUMr role <br /> soev w w.r. rtiw wr.. Bleadi and Weser Garbage <br /> Can <br /> FY.E�9� <br /> wales <br /> Ice Cooler sCaiH.-d..,r <br /> Ern.ko Sops s F"Conratowa neat ow W rrrnw caxa�..r <br /> aIorwd a kcb.a ON of No pound! <br /> 1868 E. Hazeffon Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHo 1&02 Page a of 11 TEMP EVENT APP <br /> 07MIT <br />