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1 SAN,,JOAQU!N Environmental Health Department <br /> � . COUNTY <br /> „,,E e' tl/1'IYrdYI 5► if e4e �i . <br /> 10. I any providing the following cold temperature control for tl►e cold holding of potentially hazardous foods below <br /> 46eF(if food Is used the following day, n►alnlatn bfalr)W 41•F ter►►parature): <br /> 0 Ice chests 0 Refrigerator <br /> C1 Refrigerated truck ❑ Ice bath And tube <br /> [1 Other(specify)_ <br /> 11. 1 aln providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR 0711ree compartment slnk. <br /> El 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 /> fl Tub to store wiping cloths In bleach solution. <br /> 12. 1 all) providing the following for adequate hand washing facilities, but separate from utensil wash viithfn my <br /> booth: <br /> i <br /> ❑Water supply dispenser with warm water at a minimum of 1006F(i.e.5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> ❑Paper towels and Dump-style soap container. <br /> s 13. Names of responsibl persons to 4e present in booth during all hours of operation: <br /> (� <br /> `*important"" All food vendor booths are subject to inspection. Please matte 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 /> prepamt' n and Aeration. etuni on inal to festival coordinator three weeks prior to <br /> ithis ev t. � <br /> 14. Completed by: _ �`� Am P2 <br /> Signature Title ate <br /> i <br /> 5.2a GeL <br /> Health Permit KrW.Yoh'UR <br /> � Slemowl�ChnfiM4p <br /> o�sh <br /> Papa H"Tub <br /> Soap dhperner <br /> C�11rg Baud San4is 4ucf1R1- <br /> n�a Vi.YtQ tar <br /> Banc Stave Binarh 00 wk'xm dcfs <br /> t Elfalh must be an <br /> Concrete.AspMlt, <br /> Flywood,or a Tarp. <br /> Sapp uW we:er RW4%Wer BkWY and wafer Garbage <br /> Can <br /> Fim efdin"hw <br /> . Exve <br /> wa!or <br /> Ice Cooler 5rslHandw+eh <br /> &ua kw OVS 49 FbW Cartfarnm mast bs Vlaslefl7Mr CaKahar <br /> _ _ sfamdak&VSofr0f@v9Mun0l <br /> IS68 E. Hazelton Avenue} Stockton, California 95205 T 209 468-3420} F 209 4fA-0138 I www.sjcehd.corxt <br /> EMD 16-02 Page a at tS T€W EVENT APP <br /> 07M 7 <br />