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S A NMOWN I�:Ilvironrrtentai I Iealt11 Dog artincint <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45' (if food is used the following day,maintain below 41 o f temperature): <br /> [] Ice chests [� Refrigerator <br /> [_]Refrigerated truck ❑ Ice bath and tubs <br /> (_I Other(specify) ---- - — - --- <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> I]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. 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 100T(i.e. 5-20 gallon container with spigot). <br /> 6(1 One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> [P Paper towels and pump-style soap container. <br /> 13. Names of responsible persgn,to,,pe prp .grit in booth during all hours of operation: - — <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 oriainal to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: <br /> Signature Title ate <br /> 71and <br /> 0 Gal <br /> Health Permit aslt W.et _ — <br /> If Stcmo wttfiarhng <br /> L_ _ Raper Itond Towols <br /> � Soapp dtspdnscr �---•_—.____.__�--_ <br /> Cuhmg rluard 11II If tiandtror buckol• <br /> for <br /> I11caGt I` storing w pog cloths <br /> IrI Propane St ove -- ---" <br /> l-�.�--- <br /> _ � t3oolh nurst be on <br /> Concreto,Asphalt, <br /> F <br /> 'lywoorl,or a'tarp. <br /> Pa,l•ane rank` - ---� _ <br /> Soap and Walcr Rmso Water ( 1110301 and Wt., Garbage <br /> Can <br /> hno I:r<tvtguishm --- <br /> ��� Watw <br /> I Ice Cooler 5Gil Iland warn -- <br /> J..tn. kC!rags R food Conlamas lne+st Ie, Wastewater Conta,nor <br /> steer!G!rich!,olf of fire ground; <br /> '1868 F. I la/elton Avenue :Stockton. (.;1-111folnia 9,52M I 'I. 209 468-3420 F 709.164-0138 www.slgov.org/ehd <br /> t 1f0 16.02 Pays 8 of 11 rEMP EVENT API' <br /> OG/19119 <br />