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SAN 10AQUIN Environmental Health Department <br /> l J hl•1 Y <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45OF(if food is used the following day, maintain below 41 aF temperature): <br /> ❑Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice 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 /> n 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 /> ❑ 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 /> ' Water supply dispenser with warm water at a minimum of 100aF(i.e,5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Names of resp Ible persons to b _present in booth during all hours of 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. RWturn original to festival coordinator three weeks prior to <br /> thls event. <br /> 14. Completed by: �- <br /> Signature v��-- Title Date <br /> t 5.20 Gnl. <br /> Health Permit -Stereo wfC nand was"water <br /> nafrxiq <br /> Kish ��11 <br /> f Paperi]and Towoh I <br /> I Saap dlsponaor J <br /> Cutting Hoord 1 snruluor bucko!• <br /> blaath d water for <br /> Propane Slova Broadr atadnp wiping dalha <br /> Ellooth be onsphalt,a firp, <br /> I,opano Tank <br /> <+ Soap and W.. I r ft,nsn waiar tuoarn and water Garbage <br /> 1 <br /> Gen <br /> f lro f:>,Gngidaher <br /> F>.1ra <br /> Walor <br /> Ice Cooler "y" t8 3!e9v,eMl•tiET rA7^.ktefa:, S Gal l Lind waan <br /> f=xlru tca!toga 6 r.aod Ganaincrs mual6c <br /> t Wastewater Gorgairwr <br /> stood 6Inches art or the WoWW! <br /> 1868 E,I lazelton AVerIUE I Stockton, California 05205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> I Ir)16-02 Page a of f t TFMP!°v!?NT APP <br /> 06119119 <br />