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SA N ,J O A Q U I N Environtnontal Health Department <br /> CoUf-l-I"Y. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45OF(if food is used the following day,maintain below 41 OF temperature): <br /> 0 Ice chests ❑ Refrigerator <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 /> ❑Three compartment 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 /> solution (one tablespoon of bleach per gallon of water). <br /> [a 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, bul separate from utensil wash within my <br /> booth; <br /> ❑Water supply dispenser with warm water at a minimum of 100eF(i.e. 5-20 gallon container with spigot). <br /> ❑One separate lub(bucket or basin) for the collection of rinselwastewaler. <br /> Paper towels and pump-style soap <br /> Na container. <br /> 13. me of r LLpA siblp v�ons to be present in booth during all hours of operation: <br /> JAY*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. Return orldlnal to festival coordinator three weeks prior to <br /> this event. I- -- .: .� _•� � OWNER 5113124 <br /> 14. Completed by: I <br /> �Ia1�•.r�:: f.,,.,r,s,.wy r. Title Date <br /> l.._.. .... 5.20 Gal. <br /> 11wid wash W aler <br /> i i��li'h Perntil <br /> __.__.__— 5lantowffihslaug <br /> Dish <br /> Pnpar Hared Towels <br /> Soap dlcpm,sar <br /> CuiGrgliSaard 3anlllxer[weker- <br /> woachSwaterlot , <br /> Propane SSavo Drnnth siorlog w1plao cloths <br /> Booth must be on <br /> Conorole,Asphalt, <br /> w 01 <br /> Plywood,or a Tarp, i <br /> Pr0a8is0[ank <br /> 5onp and Walar Elms Walor Peach and walar <br /> Carbage <br /> Can <br /> z <br /> Pue CIhlpuislrur <br /> E=Ira <br /> Water <br /> Ice Gaoler IIIr - 5Got Han6 Wnsh f <br /> Eku!a0 Days d FOadCalrlrrAlBrs 7r1GLr lrG11 <br /> Waclawaror Conm„or <br /> . - — - - stared 6111chos all01 Iho woulwl <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 "(209 468-3420 j F 209 464-0138 1 www.sjgov,orcg/ehd <br /> PHD 111,02 Pago 8 of 11 TEMP EVENT AP <br /> DG11 W 19 <br />