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- rayo r� i i cmr cvcrv,r+rr <br /> 06/19119v� o 0 o r <br /> I <br /> rl.V;, � SAN � JOAQUIN p <br /> Environmental Health Department <br /> (:,tl t�• .i. "<I —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*F temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑ tee bath and tubs <br /> Other(specify) Dre. <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 /> ❑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(Le.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. jg <br /> es of spons�per.1olis to present in bo uring 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 original to festival coordinator three weeks prior to <br /> this event. e� ' Z <br /> 14. Completed by: <br /> Signature Title Date <br /> 6.20 Gal. <br /> Health Permit Hand wash Water <br /> Slorno wiChafiing <br /> Dish <br /> Paper Hand Towels <br /> Soep dispenser <br /> CulUng Board SenlUzer bucket- <br /> bleach 6 water for <br /> Propano Stove Bleach storing wiping cloths <br /> Booth must be on <br /> concrete,Asphalt, <br /> Plywood,or a Tale. <br /> Propane Tank <br /> Soep and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Flra Extlnaulshar <br /> Water <br /> Ice Cooler 5 Gel Hand wash <br /> Exdre Ica Begs S Food Contalnars nwst be Wastewater Conteinar <br /> stored 6Inches oft of the ground) <br /> 1868 E.Hazelton Avenue( Stockton,California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 6 of 11 TEMP EVENT APP <br /> 06110119 <br />