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S A N J O A Q U I N Environmental Health Department <br /> -- COUINTY— <br /> 11), 1 am providing the foliowmg cold temperature control for the cold»§Iding of polerdially hazardous foods below <br /> 45'F Cif food is used the foDaviatg day,rnairdain below 4VF tempe�akrre): <br /> )k1ce chests D Refigwutor <br /> ©Refrigerated truck ❑Ice bath and hates <br /> ❑Other(specify) <br /> 11. 1 am providing the Wowing=terns within my booth for the sanitary ciearpng of food preparation utensil <br /> EJ 7hree compartment sink- <br /> OR <br /> ]Three deep tubs(basins SS inches minjm=), one for soapy water,one for rasing and one for a bleach <br /> 'Jution(one tablespoon of bleach per gallon of water). <br /> etergent,bleach,and wiping rinths(clean g towe)s)_ <br /> TUb tD store wiping-lotus in bleach solution_ <br /> 12. 1 am providing the foHaMng for adequale hand washing fardMes, but separate from utensil wash within rrry <br /> booth: <br /> >uWater supply disperser with warm water at a minirnum of 100'F(:e_-15-20 gallon container with spigot). <br /> N-One separate tub fbuckel or basin)for the collection of rinse,�Awtewater. <br /> Paper towels and pump-style soap container. <br /> 13. Nam s of responsible erson to be present in booth during all hours of operation. <br /> "7mportanr" All food vendor booths are subject to inspection_ Please make a wpy of this application in <br /> preparation for this event_ A copy of this checklist must be in the booth at all hours a <br /> preparation and oper54'ZN Return on'ainal to festival coordinator three weeks{crier to <br /> this ev t, <br /> 14_ Completed by: � a� <br /> ature "Title ate <br /> r--;--_- .--� -.7 <br /> Health Permit razes%ram <br /> o� <br /> Pafer�7crd <br /> 5�odyrasr <br /> Gs6 r�� <br /> S�viceu h«s- <br /> Hsi�L:r�r•s <br /> 1 Booth rrn[sf be on <br /> _ 1 CcrtCleSe,f sDhal4 <br /> v=nas rrsx ' {I� .. _ Plytiv+Cad.rir8 Tarp. <br /> s� rdv4a� stye trade <br /> Garbage <br /> can <br /> LJ <br /> Ice Gooier <br /> :._ar05" P"ardmegyp <br /> 1868 F-Haze ton Avenue f SiOckton,California 9521151 T 209 46&34201 F 209 469-0138 f �rnnw�jceF,d coal EMD 16-92 Pace a d 11 <br /> rrrCln7 T W EVEWA�p <br />