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SAN.:IOAQUIN Environmental Health Department <br /> --COU NTY— <br /> Crrntr,e5l yrnws here <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 El 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 /> ution(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 /> XW ater supply dispenser with warm water at a minimum of 100°F(Le.5-20 gallon container with spigot), <br /> xOne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> xPaper towels and pump-style soap container. <br /> 13. Niannep of r1sponsible persons tQ,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: <br /> Signature Title Date <br /> a-20 ca 1. <br /> Health Permit Hand wash water <br /> S:emo w1Ghe9f ng <br /> Dish Paper Hand 7osw1: <br /> Soap dispenser <br /> Q a'nB Borwd Saniazetbudrol• <br /> eieam a Water rw <br /> storey r,5piny lode <br /> Propane Stove Bleach <br /> Booth must he on <br /> Concrete,Asphall, <br /> / 0 z *ya Plywood,or a Tarp. <br /> b;k. <br /> Soap and Wwor Rinse water Bleach and water � Garbage <br /> 1r Can <br /> Fie Ending-Atw <br /> E�dre <br /> Watar <br /> Ic�eCooler saeiMandwash <br /> F dra ice gaysa Food Ca falnara mustba Wasteerafer Container.,....., efWvdainches ofrorlhagreundf <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 I T 209 468-3420 j F 209 464-0138 www.sjgov.orglehd <br /> EHb i"? Page a of It TEMP EVENT APP <br /> OW2912023 <br />