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SAN JOAQUIN Environmental Health Department <br /> —COU NTY <br /> 10, 1 am providing the following cold temperature control for the cold holding of potentiaily hazardous foods below <br /> 45'F(if food is used the following day,maintain below 41`F temperature): 1 <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11, 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR ❑Three compartment sink. k* <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 fol#owing 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°l"(i.e.5-20 gallon container with spigot). <br /> One separate tub (bucket or basin)for the collection of rinseAvastewaier, <br /> Paper towels and pump-style soap container. <br /> 11 Na es of responsible persons to be present in booth during all hours of operation: <br /> h <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 original to festival coordinator three weeks prior to <br /> this ve t. <br /> 14. Completed by: l--C�.-�S` <br /> Signature Title Date <br /> waaacxnuw arras s 5-20 U. <br /> Health Permit � Haddv.•ashWater <br /> Siama wl[:hatfrng <br /> Olsh <br /> Paper Heed Tarels <br /> 5aep dispenser <br /> a,re.,y n4.o.d Sar iraor burkd- <br /> tdaarh&ureter foi <br /> ArnpaneStave <br /> aleaeh sWrIngwiping dolhs <br /> Boolfi muss be qnConcrete,AsphPlywood,or <br /> Prapane7arbc . - - .- <br /> Rinse Waler weach and Water Garbage <br /> Can <br /> MM Edagulsher <br /> EY![a <br /> Water <br /> �lGe: Cooler e 6°ZiE Orris rr,x„r..;.,:.::nriulGwx,,,,<,' 6GalrrrS4wasn <br /> ExlralceBegs6Fo�lCanlaLtersm:rstbe WBsfBWaterCb711Blner <br /> sfnad s h cfres otf ollhe gmundl <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 468-3420 f F 209 46 -•0138 1 www.sjrehd.com <br /> EHG 1&Q2 Page a of 11 TEMP EVENT APP <br /> 0713117 <br />