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f <br /> ' SANJOAQUIN Environmental Health Department <br /> COUNTY— p <br /> Grcatness grow, hrre. <br /> ip. I 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 4 VF temperature). <br /> ❑ Ice chests ®Refrigerator <br /> ❑Refrigerated truck ❑Ice balh and tubs <br /> ❑Other(specify) <br /> 11. I am providing the following Items within my booth for the Sanitary cleaning of food preparation utensil <br /> 19 Three compartment sink. <br /> OR <br /> ❑ Three deep tubs (basins " 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 /> ©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 HnseAvastewater. <br /> ❑Paper towels and um -st le soap container. <br /> 13. Names of�resonSlblersons to bepres�entinooth during all hours of operation: <br /> --Important" All food vendor booths are subject to inspectiotT. please make a copy of this application in <br /> preparation for this event. A copy of Ihls checklist must be in the booth at all hours of <br /> preparation and op lion. Return on inat to festival ca this ardinatar three inatar three weeks to <br /> 14. Completed by. <br /> Signature title Data <br /> Health Permit 6-210 as <br /> swmrida v rtre,,,aa,,wa,r <br /> 04h <br /> 6aap�� Page Flay 7or�y <br /> Cwap fiord <br /> EEHI <br /> ix::] <br /> anttar OiKha4 <br /> eMgd� Mra�A�rw b <br /> oft' �R daft <br /> Scoth must be on <br /> Concrete,Aephalt, <br /> Pri wt TanY <br /> _ _., ' P'11+woad.Or a Tarp. <br /> Boao r,a Wow A.,aa Wow Pro Wm r <br /> r» <br /> can <br /> E�6a <br /> wa:r <br /> Ice Cooler <br /> s aM Rana r+u+ <br /> CON*W <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468.3420 1 F 209 464-0138 <br /> Erin 1"2 <br /> oer�zoz3 Page s a a I www.sjgay.arglehd <br /> TEMP EVENT APP <br /> t� . <br />