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f <br /> REC-ao8 <br /> r, 1117 , ! SAN �JOaQUIN Environmental Health Department <br /> COUNTY <br /> Greotnosa draws here. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 5e1=(if food is t.tsed the followin , maintaln below 41 OF temperature): <br /> ✓ Ice chests Refrigerator <br /> efrigerated truck Ice bath and tubs 1 <br /> ther(specify) <br /> I <br /> 11, providing the following items Wlhln my booth for the sanitary cleaning of food preparation utensil <br /> i hree 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 /> iron (one tablespoon of bleach per gallon o1 water). <br /> etergent,bleach, and wiping cloths(cleaning towels). <br /> 120b 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 /> Zwler supply dispenser with warm water at a minimum of i 00°F(i.e. 5-20 gallon container with spigot). <br /> �)ne separate tub(bucket or basin) for the collection of rinse/wastewater. <br /> kaper towels and urn -s le s .p container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> JA13PREET KAUR PADAM <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 /> preparation and operation. Retum origtnal to festival coordinator three weeks prior to <br /> this event. 1 <br /> 14. Completed by: OWNER na�zzrzo2g SUBMIT <br /> { i <br /> Signature Tille Date �. <br /> 5-20 Gal. <br /> Health Permit HanUwashwelar <br /> Slarro mchamna <br /> []'sh <br /> f nluir Ilnni Trsp:nls <br /> Sanp JisponsOf <br /> Cultinp eoaW 5anllirerbucket- <br /> bleach&walerter <br /> Propene5;avn Wench shrine WpRrls cloths <br /> Boolh rnust be on <br /> Concrete,Asphalt, <br /> r O PINvood,ora Tarp. <br /> Pmpanelanh ' - i <br /> Seepand Walor kilnsc wa:o, Btach and Water C38fhSgB i <br /> Con <br /> rife WAP(Llahar <br /> Exua <br /> Water <br /> Ice Choler S GOT M"wash <br /> - Fxtra kn flogs S rood Cohtahers ntvsf 6e whsiaxater Cdllailaf <br /> sJbred GlnMas aff of the graundl <br /> 1868 E.Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> SHID 16•02 Page 8 of i i TEMP EVENT APP <br /> a6I19119 <br />