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S A N J O A Q U I N Environmental Health Department <br /> C (DUNTY <br /> 10 I am providing Me following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45"F(if food is used ft f(lkwrtng day, maintain below 41"F temperature): <br /> ❑ Ice Chests 1 r ❑Refrigerator <br /> ❑ Refrigerated truck ! /4 ❑Ice bath and tubs <br /> ❑other(specify) <br /> 11 l am PmMing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR ElThree Compartment sink. <br /> Three deep tubs (basins " inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> ssgiUbon(One tablespoon of Meer h per gallon of water) <br /> Q Petergent, bleach,and wiping cloths(Cleaning kywels). <br /> Tub to store wiping doths in bleach solution. <br /> 12. i 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 /> E one separate tub(bucket or basin)for the collection of rinsahv2stewater. <br /> U/Paper towels and 2gmp-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> I t GI l <br /> "trnportant" All food vendor booths are subject to inspecom. Please retake a copy of this application in <br /> 7rea <br /> tion this event A Copy of this d=klist must be in booth at all of <br /> d operatic <br /> 14. Completed by: � <br /> Signature Title 'Dafe <br /> s,vo r3a <br /> Health Permit —:7.1 ro+r <br /> S.r.�o.+CrrrMq <br /> or4+ <br /> a�rand nowt. <br /> s�dnv.nr <br /> cum er+.a s«�nr tw�e- <br /> ca.s+a..a.nor <br /> Prc�r.r Surma ati.e, �friry++�*o dosu <br /> Booth moat be on <br /> Corcete.Aso$k <br /> x � Ptfwood.a a Tarp- <br /> pe�+r TaAt <br /> Saw W4 VAA0 wee womw Me h old wrr C-+6lte>S]e <br /> Can <br /> Erri <br /> YMr,r <br /> Exev tar aRs a Foee Gadww■.a"M r <br /> 1868 E Hazetton Avenue Stockton, Caiifomia 95205 T 209 46&34201 f= 209 464-0138 j www.sjcehd.com <br /> EHID 10-02 Page 8 d 11 TEW EVENT APP <br /> 07f3A 7 <br />