Laserfiche WebLink
SIGN J O A Q U I N rivir nrineni al ile-al 1l Department <br /> 10. I 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'F temperature). <br /> ❑Ice chests ❑Refrigerator <br /> Refrigerated truck [ J Ice bath arV tubs <br /> C]Other(specify) �" f <br /> 11. I am providing the following items within my booth for the sanitary cieaning of food preparation utensil <br /> U Three compartment sink. <br /> OR <br /> C '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 /> n 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 /> 2th/ater supp;y 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 rinselwastewatet. <br /> reaper towels and pumo-style soap container. <br /> 13. Names of respcnsible persons to be oresent in booth during all hours of operation' <br /> C <br /> —Important— All food vendor boo.hs are subject to inspection Please make a copy of this application In <br /> preparation for 'h•s event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. �y-- <br /> 14. Completed by <br /> Sigriat[lre Tltle Date <br /> ITHealth P-rrllit <br /> r- �-rtwr Hor.�l c.vds 1 <br /> S3t�luw tncxe;- <br /> Prry3�o ti:cve y L�'4N?' •�' s!,��yr pMl�dos. <br /> N _ Pa O must on Conurur�ta,Asphalt. <br /> Plywood.or a Tarp, <br /> Yank <br /> I [;I(ty6y':Vs� l r{!-.r. •!.'a�r� i <br /> Jf ip ti3rb:ige <br /> Cpn <br /> .Y�Lr <br /> Ice Cooler V,4—a— <br /> I IF.fri:9 r]�!:f4?T f.O--qa rrv,K.rv,;:t5 � '!'.ifw�'a M'CAY',SitP• <br /> . I-_SSe:C!!:!�`Rri G":.`f1..]C✓r.•i:.l� � L 111r <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 'r 209 468-3420 l F 209 464-013B I www.sicehd.corn <br /> EHG 16-02 Payu 2 of T 1 1£,',S?tiL'E NT AP <br /> 07iilT7 <br />