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S Q NA M I N Environmental Health Department <br /> --COUNTY------ <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 OF temperature): <br /> ❑ Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs IA <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 /> tA 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 /> KA One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-sh le soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> �wLY i Ocsr , K RKA2 OLsY""A), K/ni,12 V C) ,e4f '31Ad <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 original to festival coordinator three weeks prior to <br /> this even <br /> 14. Completed by: 7 <br /> Signature Title Date <br /> 6-2o Gal. <br /> Health Permit Hand wash Water <br /> Sltmo wlchatrrrg <br /> Dish <br /> Paper Hand TowNs <br /> Soap dspenser <br /> Cutting Board Saniltzar Duckal- <br /> hleach d water for <br /> Propane Stove <br /> Bleach storing wiping doths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> -- - . Plywood,or a Tarp. <br /> Propame Tank <br /> ------------- <br /> ------------ <br /> Soap and Water Ririe Water 91earh and Water Garbage <br /> Can <br /> Fhs Er'nc ic.a r <br /> - Ertra <br /> Water <br /> Ice Cooler i SGal Handwash <br /> Erlra Ice Bags 6 Food containers musf Le Wastewater Conuiner <br /> stored 6 6xhos oh ol7no proundl <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 07017 <br />