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S A N J Q A N I N Environmental Health Department <br /> t: 1,u N 'T' <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 J�iRefrlgerator <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 /> r°Q 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 /> ❑ 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 rinse/wastewater <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsi ern to be present in booth during all hours of operation: <br /> r <br /> **Important All food vendor booths a4l 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 threo weeks prior to <br /> t4it event. _ <br /> 14. Completed by: 'i L , -� l_ ii Z L I 1 <br /> ignature Title fi" Date <br /> 5-20 Gal <br /> Health Permit S Hand wasn wale, <br /> tn+no wlCharfing <br /> Paper Nand TcabL <br /> Soap atspMl6er <br /> C;ullr?3caf SanWer bUCKal- <br /> Weach d"Ier for <br /> irovane Stove Meats Stompwping clolns <br /> [:G""noc', <br /> h m:Asphalt. <br /> be on <br /> Oorete <br /> ywood, a Tarp <br /> r'*otane Tanx <br /> Soap antl Water Rinse Ware, Aaa.:i aa;tix� <br /> Garbage <br /> Can <br /> Fire Eongursher <br /> Water <br /> Ice Cooler 5Gal M"d"sh <br /> E>ra roe Bags 6 Feod Condoners near 6e Wastewater Cont urer <br /> 0"d 6 YXftS afror the powrd' <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 { F 209 464-0138 ( www,sjcehd.com <br /> END 16-02 Page 6 of 11 TEMP EVENT APP <br /> or,3r17 <br />