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SAKJQA,QU IN Environmental Health Department <br /> —COUNTY- <br /> IC I am providing the following cold temperature control for the rrotd holding of potentialry hazardous fps t�eMo4�' <br /> 45"F liffood is used the following day.maintain below 41-F temperature:, <br /> ® Ice chests ❑Refngeraior <br /> ❑ Reingerated truck ❑•4 a bath and tubs <br /> ❑tither(specify; <br /> 1 t 1 am providing the following items within my bootn for the sanitary cleaniN of food preparation utensii <br /> ❑Three compartment sink <br /> OR <br /> ® Three deep tubs (basins " inches minimum} one for 5 oapy water cne for rinsing arrd one for a beach <br /> solution(one tablespoon of bleach per gallon of water). <br /> j Detergent. bleach,and wiping cloths icleaning towels; <br /> ®Tub to store opng cloths in bleach solution. <br /> 12 1 am providing the followir►g for ack-cluate hand washing =acitties, but separate from utensil 'crash wrthin my, <br /> tooth <br /> ®Water supply dspenser with warm water at a minimum of 10C F o e. 5-20 gallon container with sp►xot; <br /> ❑One separate tub Ibucket or basin; for the collection of nnse,wastewater. <br /> ❑ Paper towels and pump-style scar,container. <br /> 13 Names of responsible persons to Le present in booth 1unng ail hours ors cperation <br /> Antman Flemons <br /> "Importard— All food '.vendor lzo:)Ihs are subject to inspection. Please matte a copy & mils application n <br /> preparation for this evetnt. A. ccj:y e� this check-Irst must be in the booth at all r]Jrs of <br /> preparation ark? operation Return original to festival coordinator three weeks prior to <br /> tfii+~event_ _ <br /> t'. cmpteted by if CKVFM! 8.18124 <br /> Signature Tide Date <br /> 5m r. <br /> F =alter `-i-mlt '"'"•�"'��° <br /> P— <br /> so.Pa�... <br /> rya-cm.e rerMdACM& <br /> billacrl a tea. <br /> errs, jr zk4*o�vsera <br /> I <br /> i tixtr rxatdron <br /> I I _an cts AWmK <br /> Ta <br /> •rac•�] a Ta i rp- <br /> - _— <br /> f' UMMch MM wlMer C&a*a e <br /> Can <br /> Ice Cooly �, h,�•, " �O <br /> Ago i/4e/Cairo WA. <br /> aaa C sari dr db Ad <br /> 1868 E. Hazetton Avenue ( Stockton,Cadornia 95206 I T 209 468-3420 1 F 209 864-0138 1 wwwv.sjgov.org,'ehd <br /> EMD 16402 Par ti d 17 TEMP EVENT APP <br /> 062&-AM3 <br />