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RE_C-COS <br /> SAN JOAQUIN p <br /> Environmental Health Department <br /> —C- U N T Y <br /> i,,,.,,..`' Ctcuf,llcrss afrows her(% i <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 5°F(iI food Is used 1hefollowing a y, maintain below 41 OF temperature): j <br /> 1 <br /> I e chests Refrigerator <br /> efrigeraled truck Ice bath and tubs <br /> Cher(specify) <br /> t <br /> i <br /> 11. Lfproviding the fojlowiing items within my booth for the sanitary cleaning of food preparation utensil <br /> ree compartment sink, <br /> oR <br /> Three deep tubs (basins 6-6 inches minimum), one for soapy water, one for rinsing and one for a bleach ' <br /> tlon (one tablespoon of bleach per gallon of water). <br /> L—Pelergenl,bleach, and wiping cloths(cleaning towels). <br /> �ub to store wiping cloths in bleach solution. <br /> 12. I am providing the fallowing for adequate hand washing facilities, but separate Irom utensil wash within my <br /> 3ater <br /> supply dispenser with warm water al a minimum of 100OF(i.e. 5-20 gallon container with spigot). <br /> I <br /> �ne separate tub(bucket or basin) for the collection of rinse/wastewater. <br /> Japer towels and up mp-st iev soap container. <br /> i <br /> 13. N es of responsible persons to be present in booth durinq a I hours of operation: <br /> "Imporlant" All food vendor booths are subject to inspection. Please matte 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 j <br /> preparation ratlon, Return oriralnal to testival coordinator three weeks prior to i <br /> #his event. <br /> 14. Completed by: SUBMIT <br /> ` <br /> Signature 71fie Date <br /> S-20 pet. <br /> Health Permit Hand wash Water <br /> slerrowc�haffns j <br /> ❑ish I <br /> Paper HarsYTowels i <br /> 9aop dispanSer <br /> Cutrinp Hoard Sanlrixorbueku- i <br /> blood,6weterla, <br /> anpn,r.S:ove Model, slorin xt� ping oaths <br /> i <br /> , <br /> Booth must bo on j <br /> - Concrete,Asphalt, <br /> dap; Plywood,or a Tarp. 1. <br /> i <br /> Propane Tank - <br /> I <br /> Saapart�Were) Hlnse W7- LEIEII <br /> - 'b- �tl ft)21C L' <br /> Fi re U Inq ulsi,er <br /> ExVn <br /> Wrdor ]1 <br /> Ice Cooler SOel Hanel=i <br /> f.ba Jce t7nys F 1aad Gan7ehers nrusi do Wealevvlar ca,ld�ner <br /> aHIla[1 b Jncrins PJr OJ Jr'a piMlnrtl <br /> 1868 F.Hazclton Avenue Stocklon,California 962051 7 209 468-3420 I F 209 464-0138 I www.sigov.org/ehd <br /> DID 16.02 Page Bat 11 TEMP EVENT APP <br /> 06f19119 <br /> J <br />