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r; <br /> SA N,•,J OAQ U I N Environmental Health Department <br /> i COU IVTY <br /> 1,,!„_ (,rrrlln!•`5 ff)r+1Y., IF['Y+'. <br /> 10, 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45OF(if food is used the following day, maintain below 41 OF temperature); <br /> ❑ Ice chests [,I Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> [� Three compartm ont sink, <br /> OR <br /> ❑ Throe 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 /> ❑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 dlspensor with warm water at a minimum of 100oF•(i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub(bucke(or basin) for the collection of rinse/wastewater, l <br /> I <br /> U•Paper towels and punp-style soap container, <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Gary Blanco <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 /> proparation and operation, Return orlaInal to festival coordinator three weeks prior to. <br /> tills event. Owner 5122/202 <br /> 14. Completed by: <br /> Title Date <br /> 5.20 Gaf. <br /> Health P$rmit H;w ldwaSn WHSpi <br /> slertin w Cho Ihl+p i <br /> t]Isll <br /> Paper HmtdTowele <br /> Soap dlapenSar ; <br /> CulAnq UvarJ <br /> .8anitlxor Guckol• <br /> �IcocU 8 wnterfar <br /> Plv;rota Slnvu <br /> t3iencN sienna w{phu dell. <br /> 1"—- ,M; <br /> Booth must tla Orl I <br /> CpR"rI) Asphalt, <br /> k <br /> Ptywoad,or a Tarp. <br /> Propane Tank <br /> I! <br /> Soap and Weiler RInsBWolar tiloacli BnSWeler <br /> Garhag© <br /> Can <br /> _ Fka CRllnlµllsh ar � <br /> Wmef <br /> Ice Cooler 5 Gal HalWwusl: I <br /> ,r Ez6e!cv 130ys 8 Foe Con)d ie twat bu Wnslowaler Cwih am i <br /> -. --.. --- alnred 6blrhoa on or lbo ground) <br /> 1868 tw. hiazellon Avenue I Stockton,California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov,org/ohd <br /> EHD 16,02 Pago 8 of I# TEMP EVENT APP <br /> U&liy119 <br />