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SHIN JOAUUiN lEnvironrr orittrl Health Dopartrnent <br /> lo. I 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 aF temperature)! <br /> OR-Tce chests ❑Refrigerator <br /> Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <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 /> hree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleat <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 /> r04-ate"supply dispenser with warm water at a minimum of 100°F(i.e.5.20 gallon container with spigot). <br /> neparate tub(bucket or basin)for the collection of rinsetwastewater. <br /> W41ae�e separate <br /> towels and pump-stvlo soap container. <br /> 13. Names of resp\onsible persons to be pre gent In booth during all hours of operation: <br /> "V.9 zy—cl d� q <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. R urn original_to festival coordinator three weeks rior to <br /> this ev at</•�e l �— e-I— z3 <br /> 14• Completed by: Sign t Title Date <br /> s•2o cal <br /> ' •' � Hard wash Walor <br /> Health Permit � -- <br /> Sterne wrChanng _ 1'oper Iland iowets <br /> Soap diaponso+ - - <br /> =�,mbw,"',-, <br /> 0lcoul <br /> Propane Siovo <br /> eoolh must bo on <br /> Concrete.Asphalt, <br /> Plywood,or a Tarp. <br /> 1'ropana lank <br /> Soap and Walof Rinse Walnr Illeach AM Water I Garbage <br /> Con <br /> No Extmgulshor rsva -'_, <br /> C� Wnlar <br /> 1(/ICe ^OOlef 6Ga1 Iland wash -- <br /> li ' II Wastewater Contener <br /> ,fierfa Ica nags 6 Food Contarnors must ho I _ <br /> slated 6 Mchos Co or the gfoundl <br /> -- ,- _ •J-] <br /> 18G8 U. li,lzelton Avenue Stockton•California 95205 1 T 209 468-3420� F 2.09 464-0.138 1 w`>,'w sjgov.rvcull0 F' <br /> CHO 16.02 Pago 8 or 11 <br /> OGf taff9 <br />