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May 17 2018 03:07 Postal Connections 2093560558 page 2 <br /> SAN QJ 0 AQ U IN Environmental Health Department <br /> COON FY <br /> 10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45' (if food is used the foltowing day, maintain below 41'F temperature): <br /> )ilce&ests ❑ Refrigerator <br /> ❑Refrigerated truck ❑ Ice tette and tubs <br /> 04 Other(specify) 1 <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartrmnt 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 /> Motion(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 /> IN water supply dispenser with warm water at a minimum of 1007(i.e. 5-20 gallon container with spigot), <br /> ❑One separate tub(bucket or basin)for the codec ion of rinsetwastewater. <br /> Paper towels and pump-style soap container_ <br /> 13. Names of responsible persons to be present in booth during all hours of operation_ <br /> i-t o AJ b 'U <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. Retum oristinal to f2sdval coordinator three yreeks prior to <br /> Ahis errenL <br /> 14. Completed by: e DJC <br /> Sign Title Date <br /> s2o cal. <br /> Health Permit ";.'d'.Ph"'OW <br /> sdnw wIG7vRtng <br /> Dish <br /> PgM7T Hind fawela <br /> 5[ap dkpanar <br /> Cu�inq 13oed Senkuw buckm- <br /> mooch&WWW br <br /> Pappane Slone g�p� swim w png balm <br /> BDoth frust be on <br /> ConMle.Asphah, <br /> Plywood,or a Tarp, <br /> SOW Rod WM. Rn Walar 0*&e hand wG. Gaft)age <br /> FCan <br /> �� � <br /> n- <br /> Ice <br /> Cooler I I 5 GW HafW,,,aa„ <br /> Ema kv Sagn d rand Ca ft r rnua 8o WeAawafar C.rit�w <br /> Sh7rcd 6 vx:tw cdr N OSs flVLVXP <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209468-34201 F 209464-0138 E www.sjcelid.com <br /> Elia]16-02 Pa{B 8 of 11 TEMP FVENT APP <br /> 0713117 <br /> v T May, 17. 2018 1 : 0 ' FM ilk. 56':a <br />