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S A N J OA Q U ! N Environmental Health Department <br /> - t. ir.i - <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 JR Refrigerator <br /> ,04'Kefrigerated truck ❑ Ice bath and tubs <br /> U-Other(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> . iree 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 /> NJ-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 rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be ppresent in booth during all hours of operation: <br /> _Q20-ji VYA M t V-0-A f- , 1-61'11n' <br /> "Important" All food vendor booths are subject to inspection. Please make a copy of this application ii <br /> preparation for this event. A copy of this checklist must be in the booth at all hours c <br /> preparatio o eration. Return original to festival coordinator three weeks prior t <br /> this eve <br /> 14. Completed by: <br /> Signature Title U Date <br /> 5-20 Gal. <br /> Health Permit r— Hand wash Water <br /> _ Stemo w/Chaffing <br /> Dish <br /> Soap dispenser <br /> Cutting Board Sanitizer bucY <br /> bleach&wale <br /> Propane Stove Bleach storing wiping c <br /> Booth ml <br /> Plywo de <br /> C F ap �e '3nk ,JI <br /> e ' Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> 5 Gal Hand wash <br /> Aags&Food Containers must be Wastewater Container <br /> Inches off of the ground! <br /> 1868 E Ha2 lton'Avon(.Je,' on, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov.ol <br /> EH:)16-02 Page 8 of 11 TEMP E <br /> 06/79J202,,3 ; <br /> -AIu, <br />