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a <br /> S A N 10 AO U I N Environmental Health Department <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 day,maintain below 41"F temperature). <br /> R Ice chests ❑Refrigerator <br /> ❑Refrigerated truck Q tce bath and tubs <br /> ❑Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <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 /> ODetergent,bleach,and wiping cloths(cleaning towels). <br /> GZfub 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(i.e.5-20 gallon container with spigot). <br /> Q(One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> [�J Paper towels and pump-style soap container. <br /> 13 Names of responsible persons to be present in booth during all hours of operation: <br /> Ir-ex C., A Ti I 'l 10 a s f1 �yG <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 /> u .a,�a?� s10 a■ <br /> Health Permit <br /> Slemo wKrtattaq <br /> Pe,par Nara Ttaaau <br /> 5<wp eap.nwr <br /> Gumrq er,aro Swurer euWat <br /> a1a.tYf Q wN.r br <br /> Papa ro Sm.e n <br /> a`oRy wlp+y UaMf <br /> Booth must be on <br /> Concrete.Asphalt. <br /> U Plywood,or a Tarp <br /> Propane Tani , <br /> Soap aM'Naur Ruu�Waler &earn one Waler Garbage <br /> Fin E.unoraaner Can <br /> Eats 1 <br /> wwr t <br /> Ice Cooler "'ilt>YI' Gdll66'" 5Ga nanC worn <br /> Ears Ica Brya a Foxe Cpnlaorn-w M wawewsur Cunta ns <br /> urvao a..naa nrt N rb prms.lr <br /> 1868 E Hazelton Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www slcehd cam <br /> EHD 16.02 Page a of 11 TEMP EVENT APP <br /> 0?1311 r <br /> i <br />