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;nu N SAN J <br /> _, �, �A�u�� Environmental Health Department <br /> S <br /> COUNTY---- <br /> vrentDr53 grows hrri'. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 4 F of food Is used the following d9y,maintain below 41°F lempotatufe): <br /> 112 Chests Refrigerator <br /> []Refrigerated truck ❑Ice bath and tube <br /> C]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 /> �Threa desp 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 stone wiping cloths in bleach solution. <br /> 12. t 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 or 100°F(Le. 5-20 gallon container with spigot)- <br /> [One separate tub(bucket or basin)for the collection of rinselwastewater. <br /> [;�Oaper towels and pump-style soap container. <br /> 13. Names f responsible pe ns 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 a operation.Return original to festival coordinator three weeks pELor to <br /> 14. Completed by: <br /> S gnature Title Date <br /> szo GML <br /> Health Permit sw,+ow.ra,rrm� <br /> D..n Pear w,d Tv. <br /> so.a drra»er <br /> Gmnp Bnwd E�.�di 6 rrrr for <br /> B>wHi �aM1V.Apry tbEu <br /> Flnrair Eiovs <br /> Booth must be on <br /> Con«Bru,Aspr>�. <br /> `7 Ptywood,or a TarP- <br /> 1��, anp.ne w.csr w+b WLw aMrfi r+d 5v.cr Garbage <br /> cart <br /> E ktr� <br /> n�Vr <br /> Ice Cooler — 6°'""""" <br /> LArs ko e.a,c Wed ca <br /> siarM/loch-.4 OI th-fi-Dw-r <br /> 186E E-Hazelton Avenue I Stockton,California 95205 1 T 200 468-3420 1 F 209 464-0138 1 wwtiv.sjyov.QFWehd�p <br /> EHD 1"2 Pe�n6of11 TEWLVe <br /> 07101 r2024 <br />