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SAQ �N Environmental Health Department <br /> l. ----COUNTY-- <br /> `` Greatness arows here <br /> 10.• 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F (9 food is used the following day, maintain below 41'F temperature}: <br /> ❑ Ice,chests. ❑ Refrigerator N / <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 /> OR � <br /> ❑ /1 Three compartment sink. „ /l i <br /> ❑'Three deep tubs (basins 6-8 inches minimum), one for soapy water, crie for rinsing-ar one for a bleach <br /> solution tnnP tahlasnnnn of hlPach ner aalinn 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 f6lowing for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ter supply dispenser with warm water at a minimum o€100°F(i.e. 5-20 gallon container with spigot). <br /> KPT'V.-1 firw.tloj,c,--3lac4�nn,mf:ei.nFali„aeratRr�+ar <br /> 7aper towels and pump-style soap container. <br /> 13. Nam s of responsible persons to a present in b o h during hours of o ation: <br /> r � � T`[ <br /> "Jmportant" Al food vendor booths are subject to inspection. PYease make a copy of tNs appiicafion in <br /> preparation for this event, 'A copy of this checklist must be in the booth at ail hours of <br /> preparation and operation. `Return orl loot to'testival coordinator three weeks l to <br /> this event. V V j <br /> 14. Completed by: <br /> Signa e 4 Title Date <br /> 5-20 Ga. <br /> Health Permit <br /> Stemo w/Chafrsng <br /> than <br /> �� Rapq HanC T>T�5 <br /> J - - <br /> Cutnnq Board Sarrtlzar bucicoi- <br /> hleach&walar for <br /> Propane Stnvn Bleach smnng val cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Garbage <br /> p- Can <br /> l Fztingvishar <br /> � J Wau?r <br /> ri c—e Cooler-pr 5Gal Hand wash <br /> f� Erta ke frays&rwtl Conea6r�rs ma�ee Wastewater CanianeJ <br /> .- --.- -•-...-.-xr siorerC 6 inzhas elf el rtle wnu 4r <br /> 1868 E. Haaelton Avenue I Stockton, California 95205 1 T 209 468-3420 1F 209 464-0138 1 www.sjcehd com <br /> l 1&02 Page B or 11 TEMP EVENT APP <br /> g773H 7 <br />