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SA N J OAQ U I N Environmental Health Department <br /> „ <br /> 10. t 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 ❑ Ice bath and tubs <br /> Other(specify) -e �.7,Y.r 4r--,�,:T •ro s5 <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 /> ❑ 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 /> �c 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 warm water at a minimum of 100OF (i.e.5-20 gallon container with spigot). <br /> ❑ One separate tub (bucket or basin)for the collection of rinselwastewater. <br /> Paper towels and pump-style soap container. <br /> i 13. Dames of responsible persons to be present in booth during all hours of operation: <br /> rpik— <br /> * lmportant"* 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 we gilts prior to <br /> this event" P <br /> 14. Completed by: .i,t _ AA <br /> Signature TiO16 roate <br /> A-70 Gz3. <br /> health Permit hl rd rr�h waver <br /> Slw++a vw%:he;fir* <br /> 1� P>pru IYsrrJTaviFIF <br /> $d'�CCcAEne6r <br /> Cuirirp Bcacd d!>1Li1 d Yh7CBf fur <br /> 5.1 h r <br /> Prune 5Mvs - <br /> Sleach tlaiin-w. -wne, <br /> HrxAh must be on <br /> Concrete,Asphalt, <br /> Ptywoca,or a Tarp. <br /> 3 <br /> Prnyrc Tark <br /> 90diJ FrolHxtrr fi4rx Nara e'Ie&cnend W#wr Gartoge <br /> Can <br /> Firer EaGMLLOEE <br /> EX7R <br /> Wa:Cr <br /> Ice Cooler 5 Gil rlaad vokfih <br /> Adra Jrr Baps d Feud Contabon mutt 6t WaxteiW tar C9nWner <br /> .. .-..- '' ararri 6 3rchea a7ed rJu;Srr�re�n1 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 T 209 468-3420 1 F 209 464-0138 1 ►Yww.sjgov.orglehd <br /> AHD 1"2 Pago a ai 11 Z LK;P EVENT APP <br /> Mia;fo <br />