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SAN J O A Q U I N Environmental Health DepartlTlent <br /> c s l l.l fit'l Y <br /> 10. 1 am providing the following cold temperature control for lite cold holding of potentially h7zardous foody beloan <br /> 45T(if foots is used Hie following day,snaintala below 41°F tamperalrrre). <br /> [j ice chests ❑Hefritivralm <br /> ❑Reffignrated(ruck ice bath and iubs <br /> [.-J Other(specify) - <br /> 11. 1 am pro0ding Iia following items w:lhln my bcwth for the sariltary cleaning of food preparatlon utensil <br /> L]Three ccimpaitment sink. <br /> df3 <br /> [A 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 /> ❑Detorgent,bleach,and wiping cloths(cleaning towels). <br /> n Tub In store wiping cloths in bleach solution. <br /> 12. f anti 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 100T(i.e.5.20 gallon contalner with spigot). <br /> one separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> not ctw <br /> ❑Paper towels and um -st le soy container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> 'Important" All fond 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. Return ori inal to fostival coordinator three weeks Prior to <br /> this event. Z— . <br /> 14, Completed by: _ �-E' <br /> ��Ignatsrrc Title ate <br /> s" <br /> =11ealtliPeTmil IIw %555 al.f <br /> Skrrroxl:h.1'a+g <br /> ` fXfh Papcf[+,xq I trMlt <br /> SwpChpM3d ii <br /> CJrrq NAm S�+�rrr tufk. <br /> 4't]fh 6µN.ef pal <br /> 3 YQ N'{Lig'."' <br /> Pmyaia Srtrrr 1!ka� <br /> - , -r mUSt be on <br /> exilispriarl. <br /> PIyNwwnfxl,at ai Tay. <br /> 5A+1 afk�watme 1 Ir+�+e V,'ntd FIM*h FM VMLr � Gaihagg <br /> I iJ Con <br /> FWD r4rwMw <br /> W.ler <br /> �Ice <br /> Coo[ef <br /> I: Eila kv A v%L IZIA%111.i Z". �YaNnr�tcf Corea'exv <br /> u�a�aa;��..s�rr�wn � J <br /> 1868 E.Hazelton Avenue Stockton,California 952051 T 209 468-34201 F 209 464-0138 [ www.sjcelid,com <br /> EHL)16 U2 f oRa a or 1 1 I Ekb'r-WN r APP <br /> 071371 y <br />