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r <br /> '�"�aahrll��Jl7a7 Ntt�ll rh.l.+t t. •i.u•sarrrals•.•...........____-.-..... - <br /> `r <br /> SAN JUAQUIN Environmental Health Department <br /> 1 L --COUNTY <br /> 10. I am providing the following cold temperature control for the cold holding of polentially hazardous foods below <br /> 45°F(if food is used the following day,maintain below 41"F temperature). <br /> tests ❑Rerrigeralor <br /> 2149trigerated truck Ice bath and tu <br /> El Other(specify) J C b <br /> 11. I anjpFaKiding the following items within my booth for the sanilary cleaning of food preparation utensil <br /> J�TTI-iree compartment sink. <br /> OR <br /> ,,eta deep tubs(basins 6-8 inches minimum),one for soapy water,one.'or 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. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth. <br /> ..dcef supply dispenser with warm water at a minimum of 100`F(i.e.5-20 gallon container with spigot). <br /> C se rate tub(bucket or basin)for the collection of nnsehvastewater, <br /> -,er towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hourp of ope tion. <br /> e x c eC <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. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by.. <br /> Signature Title Date <br /> S-2J G•l <br /> . t llvtt vra•h NW'.w <br /> Health Permit { <br /> o,n P.p.h/•d r a.w <br /> swu ew•rw <br /> C."a—i Ssrctter Ai[FM- <br /> rfaad+ <br /> &rx� •uwq�p•q dom• <br /> h§opai•Sm.� <br /> Booth exist be on <br /> Concrete,Asphalt. <br /> Plywood,or a Tarp. <br /> Propax ia� <br /> soap ono weer rthn.a vow hl.Kn nea Mw� I <br /> Gmuagc <br /> Can <br /> ra.eamw.,W <br /> t d.. <br /> w,n,w <br /> Ice Cooler <br /> frva rs Da4,l rowl CaawbY�u W WaHn•Yr cuaan•r <br /> uaKe a ern,ar r<a..srw.+o <br /> 186a E.Hazelton Avenue I Stockton,California 052051 T 209 468-3420 I F 209 464-0138 1 www.sjcehd.com <br /> E11D 1"2 Papn a of 1 t TEMP EVENT APP <br /> �713717 <br /> 11lnrFif(111 1:1' 111r fill rtrf0111111-,r1111 rian11r1(i m,fliRnui1Tmf71Rll unwinTi1f11°11T1, VI' <br />