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r ra, <br /> SA N J a A Q U I N Environmental Health Department <br /> 1 ,I —courlTY— <br /> • Lrl'r1l(idti; ilfnf.s 1104'' <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food Is used the following day,maintain below 41eF temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> x❑Other(specify) n/a <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 /> ❑ 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). n/a <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 100"F(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. n/a <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Kai-Kenny Chew,Yshel Lok <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 orinlnal to festival coordinator three weeks Prior to <br /> this event. 411_' <br /> 14. Completed by; Co-owner 4/27/2022 <br /> Signature Title Hate <br /> 5.20 Gnl. <br /> Health Permit Hondwashwatar <br /> 5tarnowrChaling <br /> Dish Paper Hand Towels <br /> Soap d[spenaer <br /> GWang Board SanNher buOud- <br /> bleach d wader for <br /> Prapans Slave [poach aiaMg wipinp cloths <br /> Booth M <br /> ust be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane TaaN <br /> Seep and wader Rima weler e[aerh mW water Garbage <br /> Can <br /> FNa ExWoshor <br /> Ewa <br /> wafer <br /> fle Cooleralra Aceaaps droad CoNalnera Mal be waslavalarCoraa1nar <br /> --- araredeMchesNlol!l,egramdr <br /> 1868 E. Hazellon Avenue j Stockton,California 952051 T 209 468-3420 j F 209 464-0138 j www.sjcehd.com <br /> EHp 16.02 Page 0 of 11 TE[r4P EVENT APP <br /> 0113117 <br />