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SANb�JOA UIN <br /> Q Environmental Health Department <br /> ty i' COUNTY <br /> Grcotness v:,�s Here, <br /> cloc;7 r <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the following day,maintain below 41°F temperature): <br /> ®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 /> ❑Detergent,bleach,and wiping cloths(cleaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. [ am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ❑Water supply dispenserwith warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinsetwastewater, <br /> ❑Paper towels and um -st le soap container. <br /> 13, Names of responsible persons to be present in booth during all hours of operation: <br /> Nicole Moore <br /> *AImportant`* 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 afl hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by. Owner 1/18/2024 <br /> Signature Title Date <br /> 5-Ztt Gal. <br /> Health Permit Hand wash Welar <br /> Sumo wlChaging <br /> Dish <br /> PaperFiand7ovrda <br /> leap dispenser <br /> Culling Board Sa7titicer huckel- <br /> bieach&water for <br /> Propane Stova 81a2ch stodns vilping cloths <br /> Booth must be on <br /> Canuete,Asphaft, <br /> Plywood,or a Tarp. <br /> g ap and Waler Rhea Water aWch ens walrr _ Garbage <br /> Can <br /> - Puo Ex9r�gulshor <br /> Water <br /> Ice Cooler - s Gal HarwWash <br /> F�rLa)cxBags R Food Camrelaarsmasr be 4vaslawaler Cnnla'vlar <br /> stored s kxhw eY aeft woandt <br /> 1858 E. Hazelton Avenue j Stockton,California 95205 T 209 468-3420 1 F 209 464-013B I www.sicehd.com <br /> EHD is-o2 Page a of 11 TEMP EVENT APP <br /> 071V17 <br />