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SAN JOAQUIN Envilr®nmenW Health Department <br /> °w COUNTY <br /> 10. 1 ism 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'F temperature): Ar <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 /> OR ❑Three compartment sink. 0/4 <br /> ❑ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solution(cane 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 /> 6One separate tub(bucket or basin)for the collection of rinsefwastewater. <br /> 54-Paper towels and pump-style soap container. <br /> 13. Na es of responsible persons to be present in booth during all hours of operation, <br /> If <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 original to festival coordinator three weeks prior to <br /> this ve t. <br /> 14. Completed by: - OAt, � I—C-S—L'j- <br /> Signature Title Date <br /> moor 820 Gal. <br /> Health Permit iianaerashwater <br /> SremowlOhafryng <br /> 4Ish Paper HandTmaels <br /> Soap dispenser <br /> cwu�g aea.a Sanlll�erbucket- <br /> Waach&waler for <br /> Propane Slot <br /> Bleach sle�fng wlptng clalhs <br /> Booth must be on <br /> Conaete,Asphalt, <br /> - 777 Plywood,or a Tarp. <br /> ProPancTank _ _ ..- <br /> Soap andVJaler Rinse Waler Bleach and Water Garbage <br /> Can <br /> Are E-,Wngt isher <br /> Frtra <br /> VJaie: <br /> I7ecfo <br /> oer .aaauxv ax.:ac; rn•x,x,.•;.4 5Qal HaV Wash <br /> a&v Ice Begs 8 Food Conformers must be <br /> f, 0 e-F ? tvasllntaler Conlainar <br /> stored 6 Inches Oorthe praundf <br /> 1868 E.Hazelton Avenue] Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjGehd.corn <br /> ENO%02 page 8 of 11 TEMP EVENTAPP <br /> 0713117 <br />