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SAN J OAQ U I N Environmental Health Department <br /> - —COUt%ITY-- <br /> 'Irn-,;.;t' (.fgrilnc•,i �i,a::; fn'r,. <br /> 10. t am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the foilowing day,maintain below 41'F temperature): <br /> 9Ice chests ❑Refrigerdtor <br /> ❑Refrigerated truck 54 lea bath and tubs <br /> Other(specify) -e ts*.t— <br /> 11. I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> f 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 Mallon of water). <br /> R[L)atergenl,bleach,and wiping cloths(cleaning towels), <br /> Tub to store wiping clothe 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 /> [later supply dispenser with warm water at a minimum of 100"F(i.e.5-20 gallon container with spigat), <br /> K One separate tub(bucket or basln)for the collectlan of rinse/wastewater. <br /> Paper towels and >r um -st le soaa container. <br /> 13. Names of responsible persons to be present In booth during all hours of operation: <br /> r Ir—L <br /> "''Important" All ifood 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 weeks prior to <br /> this event. ^� <br /> 14, Completed by: _ r <br /> Signature U TI a Date <br /> &20 c,a. <br /> t{at>C vra■h wale <br /> Health Per mltwCheing — <br /> rxeh Maprr tlarrdTwveh <br /> Soap d■pan>U _ <br /> ����� 6or:ir■et hurkat- <br /> deach A wafer Iv <br /> eforinq YANnJ r1aV s <br /> Propane SEovb Olaach <br /> Booth mvsl be on <br /> Concrete,AsphalraTar[, <br /> ,�f(��x ;• Plyweod,oro Tarp. <br /> R. <br /> PmpOneTank � <br /> ? Ooep al5dweter Irlisawslar naaUi and Wear Garbage <br /> Can <br /> _ Flra FitingrisSier <br /> � Wbl.r <br /> Ice Cooler �' sc■Ik■�� <br /> J'Srrra ka 8sgsd Food GDnlaNa+s marl8a wa+lawaserCaae4r�r <br /> - _ _--_-___.. �ferud8lrkhIDS o!lnr tho Orow^'rl <br /> 1868 E.Hazelton Avenue) Stockton,California 952051 T 209 468-3420 1 F 209464-0138 1 www.sjcehd,com <br /> END 16-02 Pape It 01 11 TEMP FVENT APP <br /> 0713117 <br />