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SA N J OAQ U I N Environmental Health Department <br /> CCt-JNTY- <br /> 10. 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°F temperature); <br /> Ice cnesis ❑Refricieratur <br /> ❑ Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11. I am providing the following items within my booth-fcr the sanitary cleaning of food preparation utensil <br /> OR ❑Three compartment sink. N14 - ob L nGi1 S- V"C v ateA y{Y+3 <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 /> n Tub to store wiping cloths in bleach solution- <br /> 12. 1 am providing the fallowing for adequate hand washing facilities, but separate from utensil wash urith n my <br /> booth <br /> Water supply dispenser with warm%eater at a minimum of 10G`F(e.5-20 gallon container with spigot). <br /> ®One separate tub(bucket or basin)for the colfecticn of rinsehnrastewater. <br /> ®Paper towels and pump-style soap container. <br /> 13. Narpe�s o respcnsiblle �ons to be.present in booth during all hours of operation: <br /> �1 AV�d,1 w <br /> -Important- All food vendor booths are subject to inspedion. Please make a copy of this application in <br /> preparation for this event. A copy of this checklist must be in the booth at ail hours o' <br /> preparation and operation Return original to festival coordinator three weeks prior to <br /> thl a ent. _ <br /> 14. Completed by. V+UIQ� <br /> Signature Title Date <br /> C;, <br /> Health Perini; —Ihwa.l <br /> C.1h <br /> C3a�tI F�]f�T'JWl�1 <br /> loop d1ril�vr <br /> i <br /> Gnm�Bc;.vd Sai'Qor t�aka- <br /> i [ub�Ji L♦o:or tv <br /> a-r.ana Stave � B'a�� ��7x4m�Cl0;.'15 <br /> IBoot must be an <br /> l Q Concrete•Asphalt, <br /> Plywood.or a Tarp. <br /> Fmcx+e raN -- <br /> Srapardv.aar an-awacu AV Garhagc <br /> I Can <br /> t•r.,�d <br /> FIce Cooler <br /> EYi rCV�:8 FoOC v-'Mer m<rs.•en I Waal.r��rr Cd�MYmr <br /> —� - z'caed 7i.�e5_s did any-.-vn^ j <br /> 1868 E. Hazelten Avenue 151ockton.Califomia 95205! T 209 45a-3420 I F 209 464-0138 1 www.sjcehd.com <br /> END 1r,02 Pale B❑;41 <br /> 07.'3777 T_ti?ELEt,TAFP <br /> I <br />