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SAN JOAQUIN Environmental <br /> � E <br /> Health Department <br /> ttY�� �' COUNTY <br /> 9 ' Grce.n,ss gropes herc, <br /> 90. 1 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 OF temperature): <br /> ❑ Ice chests ❑ Refrigerator / <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 1, I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑AThree compartment sink. N// <br /> ❑ Three deep tubs (basins " 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 /> 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 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 puma-style soap container. <br /> I. Names of responsible persons to be present in booth during all hours of operation: <br /> C d A J L 'Fw 0 S <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,angl operation. Return orl final to festival coordinator three weeks Prior to <br /> this event. � <br /> Completed by: <br /> Signature Title <br /> Date <br /> Health Permit S20 Gal. <br /> Starno wlChaffing Hand wash Water <br /> Dish <br /> Soap dlepensar Paper Hand rowels <br /> ctimr�eoard <br /> Sanitlzer huckm- <br /> pana Stove Bleach Wench a vmter for <br /> storing wtping cloths <br /> Booth must be on <br /> Cncrete,Asphalt, <br /> ank Plywood,or a Tarp. <br /> Soap and Water Rlnse Water Bleach and Water <br /> Garbage <br /> Ffre ExHnpulsher Can <br /> F�drd <br /> wet« <br /> Cooler 5 Gal Hand wash <br /> Fla Ice Bens d Food Contah@rn must be Wastewater Contalner <br /> stored a ofrorme 0mcmdl <br /> I E Hn7pltnn Gvnn in I Cis Ls _ !* lu __:_ nrnnr . Y -tnn nC0 qA'}n 1 C �1— <br />