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10/15/2021 14: 35 9164840264 CARMICHAEL BOX SHOP PAGE 03 <br /> SAN JOAQUIN Environmental Health Department <br /> COUNTY.----. <br /> 10. 1 am providing the following cold temperature control for the cold hotdIN of potentially hazardous foods glow <br /> 456F(if food is used the following day,maintain below 41"F ternperature): <br /> 19Ice chests ❑ Refrigerator <br /> ❑Refrigerated truck ❑ Ice Math and tubs <br /> ❑Other(specify)__ -- — �- <br /> 11. 1 am providing the following items within my tooth for the sanitary cleaning of food preparation utensil <br /> ❑'three compartment sink. <br /> OR <br /> �Three deep tubs (basins 6-8 inches minimurn), one for soupy water, one for rinsing and one for a bleach <br /> solution (one tablespoon of bleach per gallon of water). <br /> []Oetergent, 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 sepseratu from utensil wash within my <br /> booth: <br /> ater supply dispenser with warm water at a minimum of 100`1=(i.e. 5-20 gallon container with spigot). <br /> Ono separate tub(bucket or basin)for the oollection of rinselwastewater. <br /> Papar towels and pumt)-styla soa>a container. <br /> 13. Names o responsible pe ns to be pres nt in booth during all hours of operation: <br /> ""llmpartant** All food vendor booths yRum <br /> to Irlspectlon. Please make a copy of this Application in <br /> preparation for this u y of this checklist must be In the booth at all hours of <br /> preparation an o t n original to fooUval coordinator three w s prior to <br /> this event `� <br /> 14. Camp!©ted by: ,._�t'`�i�� ��._ -_-„�,, <br /> igna urea Title Date <br /> y120 Gel. <br /> Health Permit <br /> SWou WCheff"ig <br /> Piper dferd Ta+er4 <br /> Soto droygmnr <br /> aaed senYirer bucket. <br /> bleach d wrter for <br /> eF Z90Wdotl�s <br /> nrppone Rlae <br /> Bbftf3r <br /> Booth mutt bo on <br /> Concrete,Asphalt, <br /> Plywood,or R Tdirp. <br /> Propane Tank <br /> dowry end watnr Rm Wxtw 61ea h and WWW Garbage <br /> Can <br /> r� F110 EM1n4Wef»r <br /> t111 wl\J{r-yy. S <br /> Ice Gaoler 5Gad11an4waeh <br /> £rhe f�v enya 6 Food CorNe.100 rreiet 6e waemweAur Cadneror <br /> tiered @ urChea off d Ma peo rAl <br /> 16038 E. Hazelton Avenue j Stockton, California 95205 j T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> @tib 16-02 Pago 0 of 11 TFmP EVENT APP <br /> 06119119 <br />