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SAN JOAQUIN Environmental Health Department <br /> - COUNTY -- <br /> 10. 1 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 d y, maintain below 41°F temperature): <br /> ❑Ice chests ARefrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11. providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> )nkTbreesorr.P3rlment sank. <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 /> ❑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(Le.5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ❑Paper towels and pump-styte soap container. <br /> 13. Names of res ons4 persons to be resent in b oth ring a hours of eratio �i <br /> -CL�n z�. cs.� 4770J1C� J , <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 Return original to festival coordinator three weeks prior to <br /> this event <br /> 14. Completed by: <br /> Signature Title Date <br /> Health Permit Hand wash water <br /> Sremo wlL7utiing <br /> Drug <br /> Pa',,Yr Nand Tpapk <br /> CuShrN BaatE SamUzerbucW- <br /> bioxh S water for <br /> Propane Store Bleach storing wiping doths <br /> Booth must be an <br /> O Conuete,Asphalt, <br /> 11 Plywood,or a Tarp. <br /> P�a+e Te^k <br /> 3o.1A arts"''arer -se 1Amler aWxh and V%lmr Garbs <br /> ge <br /> Can <br /> Fire ExtlnryrrlErsBl <br /> Extra <br /> !hater <br /> �re CocleF �., F---'- --- _T._ S:af!land•a:h <br /> Extra ktl&VS 8 Fow canwms nws7 be WasleYrater ccn!alrwr <br /> - - zrored Bmches orr m rho gramri <br /> 1868 E_Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www_sjcehd.com <br /> EHO 1&02 Page 8 d 11 TE44P EVENTAPP <br /> 0713/17 <br />