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SAN JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> , <br /> 10. 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 da aintain below 41 eF temperature): <br /> ❑Ice chests Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11. 1 am providing the folioWng items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> I]three deep tubs (basins 8-8 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 /> ❑-Wtergent, 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 /> ❑'Water supply dispenser with warm water at a minimum of 100aF(.e.5-20 gallon container with spigot). <br /> ne separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> ❑,Paper towels and Pum -s le soa U container. <br /> 13. Names of responsible ersons to be present in booth during all hours of op ation: <br /> CA-D /� 1 <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 on i al to festival coordinator three weeks prior to <br /> this event.l' <br /> 14. Completed by: ! - - `1 - Z� <br /> $" afar rtle — D�ate� <br /> =He,lth Hannwaa wsser <br /> swnawich,lr„y <br /> a.n <br /> Pnp.r r+=,tl TawNs <br /> Soap tl'spentar <br /> Cu1Cip 3oard <br /> SarJllzer 6utlut- <br /> PropaneSlove Gle.q Awafer fer <br /> 9:ee[h staHy vAphag daft <br /> Booth mast bean <br /> _ D Concrete,Asphalt, <br /> U3 <br /> Plywood,or a Tarp. <br /> Propene Tank <br /> Soap end Water RlMa Weler Bleatlt ane Water <br /> Garbage <br /> tiro Ea&.gilsher Can <br /> Wale: <br /> FIceooier �! — 5c41 h <br /> Fxln lce Bags 6 Food Conlelners orw!he Wasrowaier Canlalnor <br /> slorad a fnceae oJrw fM ground.' <br /> 1868 E_Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> E_NO 1G02 page a or 11 <br /> 07rJ117 TEMP EVENT APP <br />