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SAN J O A Q U I N Environmental Health Department <br /> 1 C0u111ITY <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(if food is used the following day, maintain below 41'F temperature): <br /> C chests Refrigerator <br /> Refrigerated truck Xice bath and tubs <br /> ❑Other(specify) <br /> 11. I ag 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 /> 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 warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot). <br /> �ne separate tub(bucket or basin)for the collection of rinselwastewater. <br /> Paper towels and pump-style soap container. <br /> 13. N es of responsible persons 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 event. A copy of this checklist must be in the booth at all hours of <br /> preparation a op ration. Return original to festival coordinator three weeks Prior to <br /> this evert[. <br /> 14. Completed by: AW - —I— Z --2 <br /> Sign re k Title date <br /> Hantl vrush Walor <br /> Health Permit smma,vlChnlfing <br /> Dish Paper Iland T-13 <br /> Soap eispenser <br /> sanldrer hucket- <br /> Cuiling Board hleacll 6 water her <br /> dn <br /> stnp vdping ctoihs <br /> Propene Slave <br /> Desch <br /> Boolh must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> prepana Tank <br /> soap ondW-tar Rinse Wow Bleach and waier Garbage <br /> Can <br /> Pro E4ffigulsher <br /> ENrn <br /> water <br /> 6(301 Handwash <br /> Evlra ku Begadl-ood CanlefnCrs must ho wa+laweler Conlalnor <br /> slaretl a Inches err o!rho prnt,ridr <br /> 1868 E. Hazelton Avenue Stockton,California 952051 T 209 468-3420 F 209 464-0138 1 www.sj7ehd veNrnrp <br /> cm <br /> EHD 16.02 paga 8 of 11 <br /> 0713117 <br />