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SAN 1OAQUIN Environmental Health Department <br /> 10 I am providing the following cold temperature control for the cold holding of potentially haiarrJrrrt frr q llrriv <br /> 45'F (if food rs used the following day, maintain below 417 lernperature) <br /> ❑ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑Ice bath and tubs <br /> ❑ Other(specrfy) <br /> 11 1 am providing the following items wilhin my booth for the sanilary cleaning of food preparation Lrtenq,l <br /> ❑ Three compartment sink. <br /> OR <br /> ❑ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one tray a b leadh <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 min my <br /> booth <br /> ❑Water suppty 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 /> �fl Raper towels and pump-style soap container. <br /> 13 Names of res risible persons to be present in booth during all hours of operation: <br /> "Important" AJI food vendor booths are subject to inspection. Please make a copy of ttm application In <br /> preparation for this event. A copy of this checklist must be in the booth at ail hours of <br /> preparation and operation. Return original to festival coordinator three*veks prior to <br /> this ve <br /> 14. Completed by: +„ ZZ Z <br /> Signature rnio Date <br /> Health Permit Krw <br /> SWM ru,." <br /> Dan <br /> sow ae.psrwe <br /> C.+riO Fiord Cryr�r�..«w <br /> r yet+!♦.rr.� <br /> ' F,Wwa S►- 0--V- {I.scar <br /> 84x'M In13t tv On <br /> comeft 'Lwan <br /> Ph.tiexV v a'a<❑ <br /> LK.rx f�rr 1 I <br /> k—W Mw kv-1,rwf W" <br /> l dth <br /> W� <br /> Ice Cooler aGa Flow WG.n <br /> f k.k•JApW 4#-,1 firwr—■n.0 fw �`WrYwMr l:wiY�M <br /> arrM16�rl+..ail d Ia yui.l' L _._ <br /> 1868 E Hazellon Avenue J Slocklon (;alffornfa V,2()5 1 T 209 468-3420 J F 209 464 0138 1 MvW sicOld com <br /> EHD 16-02 Pape B of I r 11'Mrs F VEN I APP <br /> 07rN17 <br />