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. . SANa��'JOAQ fN <br /> Environmental Health Department <br /> ----COUNT Y <br /> ":.rFp=S'1 " 1Jf�t7,(1 i:55 tiff btl'S FF C:'r'ii. <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 /> r lce 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 /> ❑Three compartment sink. <br /> OR <br /> fThree deep tubs (basins 8-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> s tion (one tablespoon of bleach per gallon of water). <br /> etergent, bleach, and wiping cloths(cleaning towels). <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 warns 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. <br /> 13. blame ponsibrle Aerpps to be present in booth during all hours of operation; <br /> *"Important" All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this nt. A copy of this checklist must be in the booth at all hours of <br /> preparation ao, Mon. etLA on inal to festival coordinator three weeks prior to <br /> this event. �� r <br /> 14. Completed by: (� /0 -�W <br /> Signature Title Date <br /> 5-7J Gal. <br /> Health Permit St Hardvrash Watar <br /> eno W1Chaf{Ing <br /> �Ish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Curling Board Sar Mr burket- <br /> bleerh&water for <br /> PraPane Stove Bleach storing vrlping cloths <br /> Booth must be on <br /> Concrete,Asphall, <br /> " t Plywood,or a Tarp. <br /> ProaaneTank <br /> Soap ehd Water Rinse Water 8feach end Water Garbage <br /> Can <br /> Fu'e F_xlingulsher <br /> Extra <br /> VJalar <br /> Ice Cooler MMOM 5Gal Hand-:-' <br /> Erlra Ira tags d Food Containers musl to Wastewalar conttner <br /> stored 6 rnches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd,com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT AP <br /> 0713l17 <br />