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S A N J O A Q U IN Environmental Health Department <br /> —COUNITY <br /> "tr.,in;:•��' i.=rrutnrss rolus,'s !,rive. <br /> 10, 1 aryl providing the following cold temperature control for the cold Holding of potentially hazardous foods below <br /> 4?'F (if food is used the following day, maintain below 4VF temperature): <br /> R. /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• 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 100°F(i.e.5-20 gallon container with spigot). <br /> �f One separate tub(bucket or basin)for the collection of rinselwastewatgr. <br /> Paper towels and um -st le soap container. <br /> 13. blames of resp sibl person to he pre ent i booth during ail hours of operation: <br /> (�W 'i � <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. Return on inal to festival coordinator three weeksprior- to <br /> this event. <br /> 14. Completed by: At G { Q Cl/f'l,PL <br /> Signature Title Date <br /> Health Permit waand Brashh <br /> Walar <br /> 51emo vllChalfinr� H <br /> OSsh <br /> Paper Hand Tov/els <br /> Soap dispenser <br /> Culling Board SanNtxac bueket- <br /> blaach 8 uxler ror <br /> Prapana 51ove Bleach sl0dngV4pfng cloths <br /> Booth must be all <br /> Concrete,Asphalt, <br /> / 0 7 Ply%good,or a Tarp. <br /> Prapana Tank - <br /> Soap endWatar iilnsaWatar 9laachandUJatat Garbage <br /> Can <br /> at <br /> Ffra Eklrngurshcr <br /> ' E,dra <br /> Water <br /> Ice Cooleir 5 Gal Hand lrash <br /> ExfralceBags&FoadConralhersmuslbo WnalavaterCanlalner <br /> '- - - StDrad 6lpches orl ollha grovndl <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 I www.sjcelid.com <br /> EHr7 16-02 Page 8 of 11 TEMP EVENTAPP <br /> n•r D <br />