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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 /> 45OF (if food is used the following day, maintain below 41°F temperature): <br /> ❑ Ice 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 /> PKI Three compartment sink. <br /> OR <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, 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 100eF(i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub(bucket or basin) for the collection of rinse/wastewater, <br /> ® Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Gabriela Guzman <br /> "Important* All food vendor booths are subject to inspection. Please make a copy of this application in <br /> prepay ion for this event. A copy of this checklist must be in the booth at all hours of <br /> pre ratio d oper ion. Return original to festival coordinator three weeks prior to <br /> t ev n <br /> 14. Completed by: Owner 10/07/2021 <br /> S gn ture Title Date <br /> s-20 cal <br /> Health Permit ll.rnd wnsrr Vrater <br /> Starno wlChaf4rg <br /> Qish <br /> Paper Hand Towel <br /> Sonp drslx+nser <br /> Culling hoard Sanitim bucket- <br /> bleach 6 wam rot <br /> Propane Slave [peach aloring wiping Gotha <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp- <br /> I'rnpano hank <br /> Soap and Wnler Rinse Wale( nlaach and Water Garbage <br /> Can <br /> Fno Ei;Smguishor <br /> f xlra <br /> Walor <br /> Ice Cooler I i' 6 Gal liandwash <br /> Exffn(co Bags 6 Food Cownhiers anist he Wastowator Container <br /> stored 6 Hydras ofrol the gnwrld7 �- <br /> '1868 F. Hazelton Avenue I Stockton. California 95205 I T 209 468-3420 r 209 464-0138 1 www.sjgov.org/ehd <br /> Et10 16-02 Page 8 of 11 TEMP EVENT APP <br /> 68/1011 g <br />