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Note. Examples of pote.._aIly hazardous food include: meats, tai..,..es, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E.Hazelton Avei-iue( Stockton,California 95205 1 T 209 468.3420 1 F 209 464-0138 f www.sjcehd.com <br /> EHD 16-02 Page 7 of I-[ TEW EVENT App <br /> 07M7 <br /> SAN-�. W Environmental Health Department <br /> U UK,' --- <br /> {J - I aim Providing the following cold temperature control for the cold hakrmg of pctenbafiy hazardous foods below <br /> 45•F(if taoct is used the following day,malnlain Below 41-F temperature): <br /> Q tee chests ❑Refrirj.E }F r <br /> ❑Rdrkierated truck Q Ice bath and tubs <br /> ❑Other(specffy} <br /> C <br /> 11_ t am providing the fallowing items within my tooth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink- <br /> ORv <br /> 3 <br /> Q Three deep tubs (basins " inches minimum),one for soapy wafer, one for rhising and one for a bleach <br /> solution(one tablespoon of bleach per gallon of water). <br /> ❑ <br /> 1 Ln(r geM bleach.Gild wiping doths(cleaning Wwels)- <br /> Q Tub to store wiping ck tt-►s in bleach solution. <br /> i 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> f <br /> _t ❑Water supply dispenser with warm water at a minimum of Y oo't=(Le.5-20 gallon container with spigot)- <br /> - j ❑One separate tub(beset or basin)for the collection of rinsetwastewater. <br /> Q Paper towels and Pump-style soap container. <br /> `13..- -Names gtrresponsible_persons to be present-in booth-4iuring all-hours of operation_ <br /> **hnportant"* All food vendor boofhs 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#tares weeks Prior to <br /> this evertL / <br /> 14_ Completed 6y t ao °V"'I aA-A <br /> Signature Title •Bate <br /> GaL <br /> -z•F::.. ..7 <br /> Health Permrt _ rr�,a..d,w� <br /> 3ain rdC7taoQg <br /> F]vh <br /> ?aperi-IsrdTaweLs <br /> soap d( <br /> Ll�ting Board cy <br /> Prt a Sax. Bk-ch kAh. <br /> Booth[must&l on <br /> Conctete_Asphalt <br /> �.;;. �x- ;. -•o��;`"' P4viood,or a Tarp. <br /> soapawvrdw waimr BbahadNrrir Ga[ba <br /> Carr <br /> Fie ii1� vva� <br />