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�S. S A N [!J O A Q U I N Environmental Health Department <br /> COUNTY <br /> r ,*� Grva$toe Ss gri,t/t l�cie. <br /> 10, 1 am proViding the Bring cold temperature control for the cold hok&V of potently hazardous foods below <br /> 45'F(tf food is used the following day,maintain below 414F temperature), <br /> ❑ Ice chests Refrigerate <br /> [] Refrigerated truck ❑ Ice bath and tugs <br /> ❑Other(specY} <br /> 11. I 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 k-eses 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 fol"AMg for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ❑Water supply dispenser with warm water at a minim of 100°F(Le,5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> Paper towels and Quay-style soap container, tci! <br /> 13. Names of responsible persons <br /> sttoo be present In booth during all hours of operation. <br /> "Important" Ali 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 orkinal to festival coordinator three weeks prior to <br /> this event ) <br /> 14. Completed by: <br /> Signature Title Date <br /> 6.20 oat. <br /> Health Permit "M wish WSW <br /> si«�o�b+n� <br /> Oft+ P^W Hand TowNs <br /> c ao�d tt`"wz°`ardeb <br /> beach t vela kv <br /> F.r*ww Slow Bleach AO&'9 VAPkV aloft <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp, <br /> Proprne YaMc _.. <br /> Swp and w,u. aleach and WNW <br /> Coe~ <br /> F" <br /> r� <br /> Ice Cooler llrt�lult�i�ttti� sceimaea aw, <br /> ,ka Sep 1 Food Cofth ,i aaao 6a car is. <br /> aia idt Lambs add ow#MUR l <br /> 1868 E. Harelton Avenue I Stockton, California 95205{ T 209 468-3420 F 209 464-0138 1 www.sjgov.orgiehd <br /> Hio 46-W papa of 11 'rW eVEW AP"P <br /> oanMe <br />