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SAN JOAQUIN Environmental Health Department <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 /> 'fiIce chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR ❑Three compartment sink. <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(i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ZPaper towels and pump-styie soap container. <br /> 13. Names of responsible perso s to be present in booth during all hours of operation: <br /> Q-6- v1.3 Z <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 /> thi event. n <br /> 14. Completed by: fJ.� j�'d �� : 2- <br /> Signature Title Date <br /> =.1 <br /> Health Permit 5-20 Gal. <br /> Stemo W/Chaffmg Hand wash Water <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board <br /> SanitiZer bucket- <br /> Propane Stove Bleach bteach&water for <br /> storing wiping cloths <br /> _ Booth must be on <br /> nn Concrete,Asphalt, <br /> Propane Tank <br /> ' . U' t Plywood,ora Tarp. <br /> Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Fire Extinguisher Can <br /> Extra <br /> Nlater <br /> I Ice Cooler 5 and xYKnw;,x <br /> 11 e 1- <br /> Gat N wash <br /> '._,..._......_.._..Y. 'Extra fcc Bags&Food Containers must b Nlasteuater ,.,ash <br /> Extra <br /> storad S 1nchas affof the ground! <br /> HO 1 E. Hazeiton Avenue ( Stockton, California 95205 <br /> e of 109 6`�-3420 F 209 46 -0'138 ( trtww.sjcehd.com <br /> EHD to-02 <br /> 0713117 9 TEMP EVENT APP <br />