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SAN JOAQUIN Environmental Health Department <br /> r <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45:f-(ff food is used the following day,maintain below 41°F temperature): <br /> 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 /> eThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> s�ool}g�lion(one tablespoon of bleach per gallon of water). <br /> [�D tergent.bleach,and wiping cloths(cleaning towels). <br /> �ub 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 /> rater supply dispenser with warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot). <br /> One eparate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Names of responsible ersons to be present in.b9oth during all hours of operation: <br /> oec-,/1ia� /����ri��j r l/i 11f al2l <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 eerettil� / <br /> 14. Completed by: __��11 �-' <br /> Signature Title ate <br /> sio cat. <br /> Health Permit FLmda"'M WWU <br /> sterna wICAe?rq <br /> 06h Papa 11"Ta"A <br /> $atD Ct4MMlI <br /> Cw1tGRO BDiIE Si rlZM DVCkI:- <br /> Gratlt 6 motet!ar <br /> Pn'pane stove 81°ad' Wang vA;.9 tic" <br /> Booth must be on <br /> Concrete,Asphalt, <br /> 0, Plywood.or a Tarp. <br /> - .#vv, <br /> Pry Taru <br /> Snap artd Water - Rma Water B4sen arm water Garbage <br /> Can <br /> frr EaTnAWstrr <br /> Extra <br /> �I� ce Cooler 5 CAI KW"-& <br /> 7--= <br /> rrsaar a way.tet Cantalm <br /> 6 aR of the prm"' <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />