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411111111t <br />111 <br />• <br />Elfra Ice Bags & Food Conlainera muel Oa <br />stored (ache& off of The ground/ <br />Bleach end Water Snap end Water <br />Fire Exlinaulehar <br />Rinse Water <br />Edra <br />Wail( <br />5 Gal Hand W3S11 <br />Wastewater Container <br />— <br />Garbage <br />Can <br /> <br />SANIJOAQUIN Environmental Health Department <br />--COUNTY- <br />-or-7:14 <br />Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45° (if food is used the following day, maintain below 41°F temperature): <br />Ice chests 0 Refrigerator <br />O Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil El Three compartment sink. <br />Terhree 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 /> <br />12, 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />12ter supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />R‘re separate tub (bucket or basin) for the collection of rinse/wastewater. <br />aper towels and pump-style soap container. <br /> <br />13. Names of responsible pe to be. present in booth during all hours of operation; 6e,6_41.4f <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 ration. Rettirn original to festival coordinator three weeks prior to <br />this even <br />OR <br />14, Completed by: <br />igriature <br /> <br />Title <br /> <br />Date <br />I Health Permit <br />Morn() ialOtiaffug <br />Dish <br />r 5. Gel, <br />Head wash Water <br />Soap dispenser <br />Popar linnu Towels <br />CuUlna Saari <br />Ni <br />Sisech Propane alova <br />Saniazor bucket. <br />blanch & water Inc <br />Morton napIng cloths <br />.11M. <br />immirs-41111/1•••• <br />v WV" <br />Booth must be on <br />Concrete, Asphait, <br />Plywood, or a Tarp. <br />Propane Tan% <br />Ice Cooler <br />1868 E. Hazeiton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orglehd <br />END 18-02 Page 8 of 11 TEMP EVENT APP <br />05/19/19