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SA N J OAQ U I N Environmental Health Department <br /> it rnirrc' YI.+tvi hr, <br /> 10. 1 am providing the following cold temperature control for the cold holding of potontialiy hazardous foods below <br /> 45°F (if food Is used the followin y,rnalnlnin below 41"F tompornimn) <br /> e chests LPRelngetator <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 /> Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> elution (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 following for adequate hand washing facilities. but separate from utensil wash within my <br /> booth: <br /> gWater <br /> supply dispenser with warm water at a minimum of 1000F(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 purnp-slyle soapcontainer. <br /> 13. Names of responsible persons to be present In oth during all hours of operation: <br /> "Important" All food vendor booths re ubject to Inspection. Please make a copy of this application In <br /> preparation eflhis <br /> ev t A py of this checklist must be In the booth at all hours of <br /> pre arationoperati . Re rrn or! anal to fostivali coordinator threo weoks prior to <br /> P.S.- ve t, c;7 <br /> 14. Completed by: Wt <br /> Signature Title Date <br /> a 70 oal <br /> Health Permit I,",, <br /> Ny sn Walw <br /> sfama..'Cnartinp <br /> o:n <br /> Pawn wad lower. <br /> 5i�4ri{on►ar <br /> Cun^q Surd Lb <br /> m Mru.t <br /> wtvyl&Vh' <br /> Booth must bo on <br /> Conuale,Asphalt, <br /> Plywood,or n Tnlp <br /> f''ap rnA TTI� � -- <br /> Sane and Wntar Huts Watar Wcntlt nrnl lYatea <br /> r, Qalbaya <br /> Can <br /> F ire Ewtuyurher <br /> E�ua <br /> LYnlrr <br /> FIce C(J01@r fiGalliarWwa.h <br /> rj!7 <br /> Lho%nrr�f&W QrC%^Y <br /> IAA F hl:urltnn Awnuo I Slockton. California 95205 1 T 209 .1168-3420 F .109 r164.0I38 1 ►vww sJ�nv,rutrlrhlf <br /> 11 fn r M1 n% Pagn 6 of 1 1 I t All't r t N I AI'I' <br /> d;0t .1%V4 <br />