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S A N J D A W N Fnvh•orr merrft Health Department <br /> I,1 i Y <br /> 40. I am providing the following cold temperature controf for the cold holding of potentially hazefocus foods belovr <br /> 45`F(if food Is used the'ollowing day,maintain below A1'F temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck n Ice bath are tubs <br /> ]Other(specify, �� 4 <br /> 11. I am providing the following gerns within my booth for the sanitary cleaning of food preparation utensil <br /> L Three compartment sink. <br /> OR <br /> [7 Three deep tubs (baslns " inches minirnum), one for soapy water, one for rinsing and one for a bleach <br /> solution(one tablespoon or bleach per gallon of water). <br /> ❑Oetorgent,bleach.and wiping cloths(cleaning towels). <br /> )r I Tub to store wiping cloths in bleach soruticn. <br /> 12- 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> 2<Ba_ter supply dispenser voth 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 rinWwastewaler. <br /> per towels and pump-style sow container, <br /> 13. Names of responsijle persons to by orosent rn booth during all hours of operation- <br /> "Important" All food vender doo:hs are subject to inspeclion Please make a copy of this applicatjon 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 this event, originaE to festival coordinator three weeks prior to <br /> 14. Completed by; /V <br /> Signature Title date <br /> `Health Permit <br /> T' <br /> �a�•,: 1x�lcnds <br /> r.�lirgp..ti+a 1 _ I <br /> f�rnprw 4:cv. � t Uk.ws• � 1r s;.,m�w:p+,n�aclh: <br /> I li0 sr MU <br /> te.A pl On <br /> l + COncrcle.Asphsfl. <br /> Plywood or a Tarp. <br /> a.=:arerxrR <br /> �� � Gxcbllge <br /> Can <br /> Ice Cooler <br /> � fslr4 k�N�,($fGa!f:rn'Orye;i rt.sl CY. '.Vafh.aalF•(>a•loln4(� <br /> . shua'AI.a:.Y..v 4:F.'17.1 rrl.•v„Y: _t <br /> 1868 E.Hazelton Avenue f Stockton, California 952051 T 209 458-3420 1 F 209464-0138 l www.sjcehd.com <br /> E30 16-01 Nlgc r of 11 1 E.5P EVENT AP <br /> n?rs,'-; <br />