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SA N J OAQ U I N Environmental Health Department <br /> — COUNTY --- <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"F temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) %)A <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Ll 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 fallowing 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 /> C <br /> 47]One separate tub(bucket or basin)for the collection of rinse-'wastewater. <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" 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 event. <br /> 14. Completed by: r- -( - r -,� ,,— ('f'tc.`-.-)C r o e.` <br /> Signature Title Date <br /> r—---- --- I - s as cat. <br /> Health Permit <br /> asn <br /> parer Han?Iv.•,c]s <br /> C�rting� SaM.,ar¢rl,nr. <br /> t!cxh L watcr!or <br /> Propana titae <br /> 4'e:s.-It 1� �lor;,y vr�ad�Us <br /> - � Eiooth must be ott <br /> C:onunte,/tisplrnll, <br /> Piynvood,cr a Tarp. <br /> Fina.rr.T�n1 <br /> $�ap;.-q VJ�=e+ Rrr.-.�1171er Bheadt arM whirs <br /> Garbage <br /> Can <br /> J Fln_£xSt rrpnai_r <br /> Fslra <br /> ware' <br /> �I <br /> Ice Cooler I 5Gal Hand wmh <br /> Extra to[+Baga L EpCG Can!ainM�.V Gc WairSuata rpvamor <br /> slorad s inMas dr a'Mo rrw.,en <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wwtrv.sjcehd.com <br /> EH❑1r02 Aaga 8 of 11 TEMP E),`INT APP <br /> CIM1 7 <br />