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SAN J O A Q U I N Environmental Health Department <br /> 10. 1 alit 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 trunk ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11, 1 am providing the following items wlthi+ booth for the sanitary cleaning of food preparation utensil <br /> OR <br /> ❑ fv Three compartment sink. f/(III IIIJ <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). / /f <br /> ❑ Tub to store wiping cloths in bleach solution. j� !! <br /> 12 1 am providing the following for adequate hand washingfacilities, 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 /> ❑One separate tub(bucket or basin)for the collection of tin selwastewatei, <br /> r <br /> �r <br /> ❑ Paper towels and um -st le soap contairter. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> 71 .Sl leIc1.i., <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 and operation. Retijim original to festival coordinator three Mrhs prior to <br /> tl,Eis event. <br /> 14, Completed by: k/V &r��i�``' -- <br /> Signature Title IJat6 <br /> S-20 USL <br /> Health Permit H:rndwarh Wulo <br /> �remo w'Chahb+y <br /> am --n <br /> r'aDrir Hap*t"10% <br /> �SDap rpBTanser <br /> GaUingHvanl I 111 f- -- 111 Senn¢erkurlict- <br /> deatn d weler lar <br /> alnadr F stornyvu�p'uyHulhs <br /> - <br /> Booth must be on <br /> O Concrere, Asphall. <br /> Plywood,or a Tarp. <br /> f4rry:nw rarw <br /> Srrrp and W:Ac HmRa W:da Hlaarh and Wale Gafbage <br /> Can <br /> Fite ExiwW"ncr <br /> warnr� <br /> J <br /> ICE- Cooler 5Ua�HaWYmN <br /> L+f,aMe Dag&6 R.x)<1(:),01lrera unlnrl'n Wava"alar Contact/ <br /> ,rinr,16 Andmr off ofibe-gnanrrl _ <br /> 1968 E Hazelton Ave1mc, I Slockturr California 95205 1 T 209 458-3420) F 209 464-0138 www sivehd.cr,m ` <br /> stao r B-o2 Page a or I t TC-MP EVENT APP <br /> 0713117 <br />