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IN Environmental Health Department <br /> 10. I am providing the following cold temperature control for the cold holding of potential) hazard <br /> 45°F {lf f000 rs used the following nay maintain below 41 F temperature) y ous foods below <br /> 9 ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ ICe bath and tubs <br /> `'Other(specify) r ca ���� <br /> 1. f am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR ❑ Three compartment sink. <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 /> Ell Tub to store wiping Cloths in bleach solution <br /> 12. l am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth, <br /> 2'Water supply dispenser with warm water at a minimum of 100°F 0-e 5.20 gallon container with spigot). <br /> ❑ One separate tub (bucket or basin) for the collection of rinseiwastewater. <br /> ❑ Paper towels and Pump-stvfe soa container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation. <br /> litl ���`i'l•r;r, ZC'�!" <br /> �lL� �-rt. urn - (.�i �l � <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 /> prep ration and operation. Return original to fes 'yal coordinator three weeks 2rior to <br /> thi vent. <br /> 14. Completed by: <br /> Signature Title Date <br /> Health Permit <br /> I "a^:..25r hazer <br /> $lerr•0 wlChafltins <br /> Crsr <br /> Soap pr Paper Hantl TD+.eels <br /> soensu <br /> CutDrry Boar <br /> Samoxer Dutice; <br /> A'voan[s1Ove Dleao d water roe <br /> l Bleant smnng vAp N UOIhS <br /> 1 <br /> Booth muSt be on <br /> { <br /> Concrete,Asphalt. <br /> Plywood,or a Tarp. <br /> Prvoar•e Tank - �-. —'- _�`_ �.. '* <br /> Soap any Waier 4rnee Waler IEEE <br /> .rater <br /> Garbage <br /> seer Can <br /> Errs <br /> u <br /> Ice Cooler s Gal Hand„ash <br /> Er"a Ice$a45 d Fooc 31rer$-V5!]e WaSleware•Conainer I <br /> 186,9 E. Hazelion Avenue I Stockton. California 95205 T 209 468-3420 1 F 209 464-0138 1 www,sigov.org/ehd <br /> TEMP EVENT„PP <br />