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7an.20.2026 03:02 PM f]7C)R 2096472585 P 5/ 5 <br /> SA N,J 0 A Q N IN Environmental Health Department <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the following day, maintain beloW 41 nP temperature): <br /> ❑ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck [] Ice bath and tubs <br /> © Other(specify) <br /> 11. 1 aim providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ©Three compartment sink, <br /> OR �I <br /> 0 Three deep tubs (basins 6-8 in minimum), one for soapy wafer, one for rinsing and one for a bleach <br /> solution (one tablespoon of bleach per gallon of water), <br /> [J Detergent, bleach,and wiping cloths(oleaning towels). <br /> ❑Tub to store wiping Goths 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 wkth spigot). <br /> ©One separate tub(bracket or basin)for the collection of rinse/wastewater. <br /> [] Raper towels and puma-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 oElgiVal to festival coo dinator three w0eks prior to <br /> this event. ! o <br /> 14, Completed by: n- <br /> signature Title Date <br /> a•':r.•�:;7r ;Pti!a:"Tsr.,.y.•,..,� 6,20 pot. <br /> Health Permit � rlw,awaahwnrpr <br /> siamn�anamt� <br /> t)lyh PM0r Nnnd Tewni <br /> !8-1, laponaerSan,12w lvelat- <br /> Proppna Slovoh atartna Mping dolha <br /> Booth must be on <br /> Concrete,Asphalt, <br /> .. . _ . Plywood,or a Tarp. <br /> Propane'cen� <br /> Boar and WXter Filnuo Walar Mddtch oho Water Garbage <br /> Can <br /> LRrmnpul6har <br /> nENtrO <br /> wnwr <br /> Iae Cooler c.', ::rsrn�h rr : au?r__:M, MM fy 0 Oat HMO W"Oh <br /> ' S'Nfrp IFe AAga d Paad contakwa meal to i wuetewater camlalner <br /> 1868 5. Hazelton Avenue I Stockton, California 05205 I T 209 468.3420 1 F= 205 464-0138 1 Www.sJgnv.orglehd <br /> EHD 16.02 Pago 8 of 11 TEMP EVENT APP <br /> 06119/19 <br />