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S A N J Q A Q U I N Environmental Health Department <br /> r� }� <br /> —LOU r,4 1 1� <br /> Greatness grows Here, <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous roads below <br /> 45°F(if food is used the following day,maintain below 41°F temperature): <br /> ❑ Ice chests ❑ Refrigerator <br /> ❑Refrigerated truck L) l❑ Ice bath and tubs <br /> Pk6er(specify) Cr I0 &,- 55 �� -C if <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> sot ton(one tablespoon of bleach per gallon of water). <br /> [Detergent, bleach,and wiping cloths(cleaning towels). <br /> 21v`T'ub to store wiping cloths 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 /> )_C 4 ater supply dispenser with warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot). <br /> ne parate tub(bucket or basin)far the collection of rinse/wastewaler. <br /> ` aperowels and pump-style soap container. <br /> 13 Names of responsible persons to be present in booth d ing all hours of operation: / <br /> —important— All food vendor booths are subject to inspection. Please make a copy of this applicator+ 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 /> thhis�vent.t / / J <br /> 14. Completed by: f / Q�� �L� L, <br /> Signature Title pat <br /> s:e cat <br /> Health Permit Hand"aan-A.'r <br /> su,r.�w:cnxnrr� r <br /> osm <br /> Ppor•+anC Forlglr <br /> Sasv EgOM19lr <br /> Cynrp 6uare Sranzr,a,urc• <br /> alert+3 wale,br <br /> pf�+e s� l3larrsi smnp wyry xllus <br /> Booth dust be or <br /> Concrete.Aspria4. <br /> - - PIYwand.or as Tarp. <br /> t3aay ar,d Wave Metsa rirWr Huuri and WeWr CiafCk3g9 <br /> Can <br /> Fe.Ealnyufrurr <br /> E�ur <br /> WrWr <br /> Ice Cooler 6Grl HowwaFn <br /> ♦:al,e 1(s 8pe i ftW C&%*kWe a 51 ba WAller'Mlrf CuuWuinr <br /> emrw 0 retleee aN of gee p=.%t <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 ( wvvw,sjgov.org/ehd <br /> FHt)16-02 Page B of 11 TEMP EVENT APP <br /> o�fotrzo2s <br />