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010/1171, <br />Title ate <br />Piper Hand Tnnnie <br />%raptor taxa* <br />Mead, a welts fix <br />S aw/ agenti clam <br />Booth must be on <br />Concrete, Asphalt, <br />Phmood, or a Tarp <br />SAN JOAQUIN <br /> Environmental Health Department <br />Greatness VOWS he, e. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day. maintain below 41'F temperature). <br />[2rIce chests flRefrigerator <br />Refngerated truck fl Ice bath and tubs <br />D Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />D Three compartment sink. <br />OR D 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 />El Tub to store wiping cloths in bleach solution <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Ej Water supply dispenser with warm water at a minimum of 100 'F (i.e 5-20 gallon container with spigot). <br />fl One separate tub (bucket or basin) for the collection of nnseiwastewater. <br />fl Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth dunng all hours of operation <br />e (. ("Nx\c-k k-•\ 1..A_Ar\tx.‘ Acd <br />All food vendor booths are sublect 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 />Signature <br />AI A .1 <br />1 <br />L <br />"Important" <br />14. Completed by <br />Health Permit Stemil wortn,4114.9 <br />I tver.te., <br />I Propane tar:404 <br />1 —J <br />Ice Cooler 1.-- 5 Cosi Wind am,* <br />Arosaipwr__ currkimor n ,cr ao Hap f,./(....nanna, ORM NO <br />OurogJ 4 mess ,J,í woe <br />1868 E. Hazelton Avenue I Stockton, Cahforrua 95205 I T 209 488-3420 I F 209 464-0138 I wvvw.sigov.orgiehd <br />Ere) 1642 Pegs 54 I t 'OAP EVENT APP <br />06090023