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SIGN 10A0UIN Environmental Health Department <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45T(if food is used the following day, maintain below 41 eF temperature): <br /> Joice chests ❑Refrigerator <br /> Refrigerated truck (]lce 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 /> []OR Three compartment sink. <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 wilhin my <br /> boath: <br /> Water supply dispenser with warm water at a minimum of 100'F(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-s!_xe soap container. <br /> 13. Names of responsible portions to be preset t in booth durin ati hours of operation: <br /> "important-- All food vendor booths are subject to inspection. Please make a copy of this apphcalion in <br /> preparalion for this event. A copy of this cheekllst must be in the booth at all hours of <br /> preparation and operatio . Raturrr orf final to fastival coordinator thre weeks rior to <br /> this ov it. <br /> 14. Completed by QLUr1 <br /> O ,I �—SI(lnatur° Tiito <br /> Health Permit S-�o ra <br /> -- Sumo w!( arhrp — flara •Ili Wat,r --- <br /> Ufn -I <br /> Pp.,11lM Tov,rle <br /> Snen eilpenl•r .I <br /> -- <br /> ssns,..wu•- <br /> r'"M'J4.Static _ tl•tU 8 w,rp far <br /> —� W.Jcn _ IIOJIiIp wgnr tlxnl <br /> 1 Dooth 'U .bo on <br /> Concrete,Asphalt. <br /> I'r�vJne irq .. Plywood-or a i arp, <br /> soap ar.c wxJr R—W.W m•.cn wb w_� I er <br /> Garbage <br /> �— c've L.Inp,p.ner Can <br /> w <br /> Ice Cooler <br /> S G.i Is.nr w.an <br /> l.+A R.0tpJ�Face Gay.kr•ri nwt!Dn( , WJlhwai•r Co•rla�.e• <br /> s+wndE.regrr ar orenr O'.wltlr �! <br /> 1360 l: lfa7ollon Avenue t Stockton.Califofrnn 95205 I T 200 d68-34'..0 f 209 464-0138 1 WVAV slgov er!)ielfrl <br /> rna 16.02 <br /> 05119119 Page a of 1 I <br /> TEMP 1'VFH7 API <br />