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SAN JOAQUIN [ nvircnunc-)rraW� Heakh <br /> --- C d U f'-J"Y- <br /> ',r r�le',r[rly•: liiiP�S ile'I,. <br /> 10, f am 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 belarr 41 OF temperniure), <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> Other(specify}.�Io��l(yOr. � �U�,�.. <br /> 11. I am providing the follovrfng items%vithin my hooth for thr sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> Three deep tubs(basins " inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solution(one tablespoon of bleach par gallon of watcr). <br /> ❑Detergent,bleach,and wiping cloths(cleaning tOWeN). <br /> ❑Tub to store vAping cloths in bleach solution, <br /> 12. 1 am providing the following for adequate hand wazhing facilities, but separate from utensil wash within my <br /> booth: <br /> ❑Water supply dispenser'rrith warm water ata minimum of 100°F(i.G.5-20 gallon container tivith spigot). <br /> ❑One Separate tub(bucket or basin)for the collection of rinseNjastr .water. <br /> ❑Paper towels and p—u�� 1_o soAp container. <br /> 13. Names of r on fe erson.•to be present in booth durin. all Guts of peration: <br /> � _ � _ <br /> '�importanl`" All food vendor booths are subject to inspection. Please make a ropy of this application in <br /> preparation for this event, opy of This chcclslist musR be in the booth at coil hour-,, of <br /> preparation and operatio urn ori incl to festival coordinator three tveeks rlor to <br /> Ellis event. <br /> 14. Completed by: � <br /> Sig_n to Title ate <br /> IE�rdwn::r4vUer <br /> Health Permit csarou au Jv <br /> p;sh rf.:r� TTclxls <br /> ^vfmr LvhG'- <br /> cd+rMJ cc-as E,'CJLirA W.ACr for <br /> f'CN1aYrtjd+1,7 GY7rh5 <br /> Hoath-,mist he wr <br /> { c�r,�ri�,rrantwn, <br /> / - - I zi 1c;', Plywood,or a Tulp. <br /> v�rr�oTrry <br /> Gcr,oMW:car lc�teW7%+-•= [lY.unc�rASh".� � Ga;Liar�s <br /> —Can <br /> FirnEa:r�l:hcr <br /> arra — <br /> rjce�Coofer ,IXuat" <br /> I; FzhokoUs7yGfuWC4iilGntssrcr:leo { _Yvrttua—✓rCUtc'ncr R <br /> -_- !! GaC7Glr�7rcaorloJrao�vnCr ...JJJ <br /> 18631-.Hazelton Avcnue f Stocidon,California 052051 T 209 468-3420 l F 209 464-0138 1 t•Avw.sjrehd.com <br /> EiiO 10-02 Pt:�rs o of i1 TEf rP LVE-14T APP <br /> VW17 <br />