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4113126,3:49 PM proffle7.cfm(30204032) <br /> ,SAN. JOAQUIN Environmental Health Department <br /> CaL N I Y <br /> 10. 1 am providing the following void temperature control for the cold holding of potentially hazardous foods belaw <br /> 451=(if food is used the foifowing day,rnaintaln below 41°F temperatura): <br /> ❑foo chests ❑Refrigeretoi <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Othor(specify) <br /> 11. 1 am providing the following Items wilhfn my booth fur the sanitary cleaning of food preparallon utensil <br /> OR LJThree ccmpartrrant sink. <br /> ❑Three deep tubs(basins"inches minimum),one for soapy water, ore for rinsing and one for a bleach <br /> solution(one tablespoon of lsleach per gallon of water). <br /> ❑Datergsni,bleach,and wiping cloths(cleaning towels), <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. i am providing the following for adequate hand washing facilities, but separate from utensll wash within my <br /> tooth: <br /> ❑Water supply ellspenserwfth warm water at a minimum of 100°F(i.e.5 20 gallon uonlainor with spigot). <br /> ❑Ono separate tub(bucket or basin)for the collection of fin selwasfeweter. <br /> ❑Paper towels and puwa stv soao container. <br /> 13. fumes of responsible persons to be present In booth during all hours of oparation: <br /> Q U <br /> "Important" All food vendor booths are subject to inspection. Please make a ropy 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, $etuM ortc_Inal to{es )_g�ygrdinator thrne�+r+�gks prior to <br /> this event. <br /> 14. Complated try: i.k,Y\.r f ll <br /> /,? <br /> ` <br /> Signature TltteD to <br /> � <br /> ab om <br /> Neallh Permit r �� - Ilxalw hLknR <br /> 5lerrro wla:+rrd <br /> ow! <br /> Sxy ds+.ryq <br /> C/:np noxd <br /> Scolex bxka4 <br /> RO{W1e Slane Wei•h I{Mlllr r� <br /> akedN�7+Y4�V a+!, <br /> Booth count be on <br /> Cnncretq p phalt, <br /> Plywood,or a 7a <br /> �:a'd L1Y:�- -Ihx�:`rY.s ekadl xd LVa:r <br /> - � Garbage <br /> Fro txe*�—e w Cnn <br /> Ice Cooler !.j <br /> �_ <br /> �� LrM1a ka Bapa i Fwd GYMArnaa must Ea Yhlivwttr Cq�kyw � <br /> dart r r+lahae rNfa•!Ap prtiuc'r <br /> 1808 E.Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 F 209 464-01:3R <br /> F tsps I www•sjgoy.argland <br /> Papoilort! <br /> 0770f12a�5 _ - - 'rE:A6PFv£NTAPP <br /> dI <br /> t <br /> hitps:llconvenlionforce.comfelprofi107.cfm7downtoadpid2625897&intxowse-1 1J1 <br />