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S A N - J Q A Q U E N Environmental Health Department <br /> -- CourvTY---- <br /> �rCC!r„:s :brows �ir .•. <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 /> X 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 /> !i& 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 /> ❑ One separate tub (bucket or basin) for the collection of hnseiwastewater. <br /> Paper towels and pump-style soap container. <br /> 13 Names of responsiblepec ons to be present in booth during all hours of operation: <br /> LAC � j �i./V_r-f L1 _ ._. <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..' Re rn original to festival coordinator three weeks prior to <br /> this eventt �1 ,f�i Ott." r +�)1'l� <br /> 14. Completed by' V,*--U ( --),t' <br /> Sign turn Title Date <br /> Health Per <br /> o-� <br /> Soap dst^'an <br /> ss,a,:e. + <br /> L+eadi a rs'a•*ICY <br /> E'exn •'a"'0—Pn4 c'ct*•S <br /> Boolh must be on <br /> Concrete,Asphalt <br /> Plywood•or a Tarp <br /> Rn -.Tn-e <br /> ------------ <br /> - �o C aM:�a'« it nee Y/a•r• 0'a.c}•sn]1'd�•« <br /> Garbage <br /> Can <br /> rlice CWer :G] Il,l rl Math <br /> L.'a ka Gegs3f:..•;'. •+'-�^,.s'to w1l'.w a'ry CCnlV. <br /> 1868 E Haze;ton Avenue i Stockton CaVornia 95205 € T 209 468-3420 1 F 209 464-011 38 J v.m-& s1gov orglehd <br /> V10 10 02 r'apu Fl o't I I MV CVt NT Ar'P <br /> �rrolrro�s <br />