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1=fl <br /> SAN 'JOAgU� N Environmental Health Department <br /> t ,. --COUNTY— <br /> �=l rr,�:,v�'• Cyr,-a t-n v%s Ll ro4vs hcrv. <br /> 10.. 1 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 aF temperature): <br /> ❑ Ice chests Q 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 /> 0 Three compartment sink. <br /> OR <br /> ❑ Three deep tabs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> so Ion.(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. 1 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 /> X0ne separate tub(bucket or basin)for the collection of rinselwastewater, <br /> ❑Paper towels and pump style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> **Important** Alf food vendor booths are subject to inspection. Please make a copy of this application in <br /> Lph ' <br /> for this event. A copy of this checklist must be in the booth at all hours of <br /> nd op ration, Return original to festivalcoordinator threeweeks prior to` <br /> 14. Completer}b : R �Q� if�lP��C 1 � <br /> 5ign.ature Title Dete �A�� �� 2�, <br /> T s20 GsL dd ✓I <br /> Health Permit -Hand <br /> Weshwaler '(f <br /> s�mawlcratb„s ( L <br /> Dish <br /> Rader Hared 7orva[s <br /> Soap dspenscr <br /> GutGag_Soard $Brdlf7ar huricef- <br /> hteacfs&WWIgr- <br /> Prapene Slave B(asrh steng Wiping s <br /> I <br /> 8oalh must bs on <br /> ,�' -, t _ Concrete,Asphalt. <br /> _ -�- �' Plyxlaad,or a Tarp, <br /> PrgpanaTsnk <br /> `.3 !!.'and Water Rinse Lt'aier i Bfaaehvnd Water Garbage <br /> 9 <br /> Fire Edinguisher Can <br /> IE>z:ra <br /> :ti'alnr <br /> Ice Cooler fiT -Nr,-�;� seal Ffana wash <br /> Erlra rse Bags d FaodConIs'rn2ra r>tusl he ' WaslawatRr Contalner <br /> stored 6inches of&lhe gxvndl <br /> 1868 E. Hazelton Avenue j Stockton, California 952051 T 209 468-3420 F 209 464-0138 1 vvww.sjcehd.com <br /> EHD 18-U2 Page 9 of 11 TBAP EVENT APP <br /> 6713l17 <br />