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S A N 10 A Q U I N Environmental Health Department <br /> 10 1 am providtng the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F (d food Is used the following day,maintain below 41"F temperature): <br /> ❑ Ice chests % Refrigerator <br /> 59ipefrigerated truck ❑ ice bath and tubs <br /> ❑ Other(specify) <br /> 11. m providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> 1 <br /> Three compartment sink. <br /> OR <br /> El Three deep tubs (basins 6-8 inches minimum) one for soapy water one for rinsing and one for a bleach <br /> so ubon (one tablespoon of bleach per gallon of water) <br /> Detergent, bleach, and wiping cloths(cleaning towels) <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 /> �f Water supply dlspenseF wrth warm water at a minimum of 100'F ri.e. 5-20 gallon container with spigot). <br /> ❑One separate tub;bucket or basin)for the collection of hnsemastewater. <br /> ❑ Paper towels and pume-stvie soap container. <br /> 13. Na es of responsible persons to be pfeaent sn booth during all hours off operation <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. FbAurTm original to festival coordinator three w1gks„prior to <br /> this ev n <br /> 14. Completed by <br /> lens uro Title Date <br /> &2] GJ_ <br /> Health Permit Kand " Wsw <br /> 5m,o w+Cro+hry <br /> Sae:,d.gr+sr <br /> Cut9rp Bow 5&%tm DL%J.* <br /> bNaGh A.now 1ff <br /> We pane giavr p�.rr axrq•IPna etane <br /> BDoth mull be an <br /> Concrete.Asphalt. <br /> Ptywood,or a Tarp. <br /> wxar+e T erw <br /> GOrb6ge <br /> Can <br /> Fin E,mnpu.rnr <br /> Ears <br /> Water <br /> Ice Cooler Sae YW+C Wnti <br /> El�.•e iw$lqi d FOW CLnlallwl mrc O. W.M..~c01O.9.r <br /> srors0 C:,Awes M d Ar prt�w+d <br /> 1868 E Hazelton Avenue I Stockton, California 952051 T 209 468-3,420 1 F 209 464-0138 [ www.sjcehd com <br /> EH❑1"2 Pegs B d 71 TEMP ANT APP <br /> 67r&l7 <br />