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S A N J O A Q U I N Environmental Health Department <br /> '_ e_1 r- <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous fcxxts below <br /> 4S"F(if food is used the fotiownng day, maintain below 41'F teanperalure): <br /> ❑ Ice chests ❑Refrigerator <br /> Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11 I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> (�Off Three compartment sink. <br /> ❑ Three deep tubs (basins 6-8 inches minimum). one for soapy waiter, one for riming and one for a bleach <br /> sdution(one tablespoon of bleach per gallon of water). <br /> ❑ Detergent, bleach,and wiping cloths(cleaning toweis). <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 /> *ater supply dispenser with warm water at a minimum of 100`F (i.e. 5-20 gallon container with spigot). <br /> ❑ One separate bub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container- <br /> 13. Names of nr4xxmibis persons to be present in booth during all hours of operation: <br /> S Lr, <br /> "Important" M food vendor bootlts are subject to wispectim. Ptease make a copy of this application in <br /> preparation for this evenL 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 !o <br /> this event _ V`A "� r f <br /> 14. Completed by. _ lr <br /> Signature Title Date <br /> s-srr Got <br /> Health Permit "1 <br /> sr,o rv.rrq <br /> Poo.. <br /> sopp a.�vretr <br /> csif,a eu.a Sher <br /> Booth must be on <br /> Conm te,Asphak <br /> m'r Ptyvrood,or a Tarp- <br /> r*rgwM Twk <br /> Sam Ord w.rr Rr"M W. Bena Mcf Wow <br /> Can <br /> rip Eapnnur,. <br /> r qr+ <br /> war <br /> Ice Cooler srrf,..a..r+ <br /> £lien k e Seep 4 law C.an&wwp.a&*jW be Waprapr Cor wwt <br /> y V 6 itihrp of of he wft" <br /> IBM E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.slgov orgiehd <br /> EHo M-02 Page a d 14 1EUP EVEN APP <br /> b7/U M24 <br />