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SAN oJOAQUIN Environmental Health Department <br /> '- --COUNTY— <br /> _. ;T <br /> Greatness gro'Ns here. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below; <br /> 45°F(if rood is used the following day,maintain below 41°F temperature): <br /> ❑ Ice chests ❑Refrigerator , <br /> t•.• <br /> Refrigerated truck ❑Ice bath and tubs : =. <br /> ❑ Other(specify) <br /> 11. Jam providing the following items within my booth for the sanitary cleaning of food preparation utensil 'x <br /> 1`-�"`s•1ree 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 /> ❑Tuts to store wiping cloths in bleach solution. <br /> 1 am providing the following for adequate hand washing faculties, but separate from utensil wash within my <br /> booth; <br /> Water supply dispenser wfth 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. Narrpfs of responsible ers ns to be present in booth during all hours of operation: <br /> "Important" Alf food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this event A cop. .,t ',Nu checklist must be in the booth at all hours of <br /> preparation and operation. Return ordinal to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: a �f � Sri <br /> Signature Title Date <br /> Health Permit <br /> Stmno NrGaGury _ <br /> sN�;ate••J �, _ <br /> Cutinp6oard " .. ` •",me•µ. <br /> r- Les�.h wlW ku <br /> Propane Move 1 <br /> Eo-It%must be on <br /> V P�ywiind,or a Tart). <br /> kIce Ccoler <br /> E+La?n•,a.Qt��v[c Csjmoy�,r u , (T!r��.�.q�to-�d�,^ .,,, w � <br /> � �•Cr �r I,rt�j( 4 r <br /> 18 t3 E. Hazeftot� Avenue SEA cktan 'Califvrn la rJ5205' T 209 au9-'A2L F <br />