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SAN J O A Q U I N Environmental Health Department <br /> 10. 1 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 below 41°F temperature): <br /> ❑ Ice chests [refrigerator <br /> [Refrigerated truck ❑ Ice bath and tubs <br /> [,Other(specify)__.,.k A e e 7-m <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 /> solution(one tablespoon of bleach per gallon of water). <br /> ❑ Detergent,bleach,and wiping cloths(cleaning towels). <br /> ❑ Tub 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 /> [q*ater 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 Onsetwastewater. <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> S1 M O 4 <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. Retum original to festival coordinator three weeks prior to <br /> this event. �+ <br /> 14. Completed by: / ar,A Q'� Z41-1? 2L <br /> Signature TKOO Date <br /> szo ew <br /> nand wafn W akr <br /> Health Permit <br /> Stn no rxhartIng <br /> �^ Paper wrW Tw 111 <br /> soap dapeRler <br /> c+mvq Bo,rO samuo'MMM%. <br /> brach A Waw" <br /> Pro¢arhe Seove <br /> Bleath 'Wrng w4wv done <br /> Booth must be on <br /> Concrete,Asphalt. <br /> plywood,ar a Tarp. <br /> Propane Tank <br /> soap and wafer Rinse water Bleach and water Garbage <br /> Can <br /> Fire Fitrhgrlslher <br /> EYtra <br /> ware. <br /> Ice Cooler 3Wl H"r sh <br /> E,►a lea Bogs L Food ConUmws must be W,slewatrr Cortavher <br /> Mew E nc and Cw gT cr <br /> 1869 E. Hazelton Avenue I Stockton, California 95205 1 T 209 465-3420 1 F 209 464-0138 I vNN,,I.sjgov.orglehd <br /> EHr}15-0 Page B or 11 <br /> TE YAP EVENT APP <br /> D609r.!023 <br /> Scanned with CaMSCanner <br />