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SAN-1,­JOAQUIN Environmental Health Department <br /> —COUNTY <br /> -101 W I(?I e. <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 /> ❑ too 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 /> F1 Three compartment sink. 0 �� <br /> OR <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 /> El Detergent, bleach, and wiping cloths (cleaning towels). <br /> D 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-, 0 \�\ <br /> ❑Water supply dispenser with warm water at a minimum of 1007 (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. N, mes of responsible persons to be present In booth during all hours of operation: <br /> "Important" All foodUndor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this event. A copy of this checklist must he in the booth at all hour's of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event <br /> 14. Completed by: �_ <br /> Signature Title Date <br /> R-20 Gal. <br /> J <br /> Health Permit <br /> Hojid waah Wa,: <br /> '10 <br /> Dish Paper Hand Towel <br /> Soap dispenser <br /> Culling Board Sanitizer bucket- <br /> bleach&water for <br /> Bleach storing wiping Cloths <br /> Booth must be an <br /> Concrete Aspbalt, <br /> N7Plywood,or a Tarp, <br /> Propane Tank <br /> M'1_.v.­ - <br /> ------------- <br /> SoapandWater Rinse Water Bleach am Water <br /> Garbage <br /> Con <br /> Fire Extlnpulsher <br /> Ice Cooler 5 Cal Hand wai;h <br /> Extra Ice Begs d F,)Qd Conf.Thars must be Wastewater Container <br /> sJored 6 Inches offol'the grwrrdl <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 468-3420 F 209 464-0438 J www,sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06/19110 <br />