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SKJOQQUIN Environmental Health Department <br /> C(JlJNI1 <br /> t'1 rt111101 1fl utv% 111,t v, <br /> 1t1, 10111 imovlding the following cold lempomlun► mxilrol for the wid holding of polontinliy hnznrdous fotAn below <br /> 45T(if(uucl In used Ilro follrnvin(l dny,mltlnlnln below 41"F tornpornturo): <br /> (]100 ohonta 1zRofrigornlor <br /> Refligomted Imck ❑len bath and tubs <br /> ❑Othor(spocify) <br /> 11. I Aln providing the following1 Items within my booth for the sanitary cleaning of food proprrrnilon ulonsll <br /> OR (C�1liroo conl�uirintnnt'1111k. <br /> Thme deop tubs (bnsins 6.0 Inches minhnum), ono for soapy wator, ono for rinsing and one for a blonch <br /> solution(01)0 tablospoon of blonch par dnllon of walor). <br /> ❑Dotorrjonl,blench,and wiping cloths(clonrting towels). <br /> ❑Tub to stole wiping cloths In blonch solution, <br /> 12. 1 am providing the following for ndaquato hand washing facllitios, but soparato from utensil wash within my <br /> booth: <br /> ©-Wnler supply dispenser with warns water at a minimum of 100eF(i.e.5-20 gallon container with spigot). <br /> ©Ono separnto tub(bucket or basin)for tho colloction of rinse/wastewater. <br /> E Paper towels and pump�stvle soap eontalnor, <br /> 13. Names of responsible parsons to be present In booth during 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 tills event. A copy of this checklist must be in the booth at all hours of <br /> proparation al d.,operallon. Return original to festival coordinator three weeks prior to <br /> this event. / /11 <br /> 14. Completed by: �ivt-✓� Gam,U' /3 d <br /> Signature Title <br /> G-20 001. <br /> Health PermlI Hand woahWolor <br /> Slorno wChalnna <br /> Dish <br /> Paper Hand Tawols <br /> coop dispenser <br /> Cuthrg7 DaiM Sonhlxor buckol- <br /> Wench S water for <br /> R�pano Slmro stench slodnp vdpinp cloths <br /> Bach must bo on <br /> Concrete,Asphall, <br /> Plywood,or a Tarp. <br /> PnVana Tank ; <br /> Soap and Water Rinse Wotor Wench and Water Garbage <br /> Can <br /> Fire Extinoulshor <br /> Fxtra <br /> Wmor <br /> Ice Cooler 5Oal114ndwnah <br /> Ertro Ice Daps d Food Containers must be Wostowalor contnlnor <br /> atotod d Inclws ofi of file gruundl <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 10.02 Pa0o 0 of 11 TEMP EVENT APP <br /> 0611011f) <br />