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i� 10, l am providing the following cold temperature control for the co$d hodling of potentially hamrdous foods below <br /> 45°F(if food is used the following day,maintain below 41"F temperature): <br /> ®Ice chests ❑Refrigerator <br /> f2efrit}erate�l frk]G3: ❑Ice bath and tubs <br /> ®other(spec' <br /> �s 11. l am providing the following items wtthin my txotth far the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> Three deep tubs (basins 6-8 inches r h*Dum), one for soapy crater, one for rinsing and one for a bleach <br /> solution(one tab3espaun of bleach per gallon of water). <br /> ❑Detergent,bleach,and wiping cloths(ding Rmels). <br /> ❑Tub to store►6siping ckths in bleach solo an. <br /> 12. 1 am providing the following for adequate hand gashing facilities, but separate from utensil wash within my <br /> booth- <br /> 9 dater supply dispenser with warn water at a minimum of 100'F(i.e.5-20 gaffae~a container vrith spiaot)- <br /> ®One separate tub(bucket or basin)for the collect m of rinselvrastawater. <br /> ❑Paper towels and purnp-s_t&soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> lin <br /> 'rrtp�rFarrt** Al!food vendor booths are subject to inspection- Rease make a cry of his applicator <br /> preparabon for this event_ A copy of this checkWt must be in the mouth at A hours of <br /> preparation and opemtorr. Rehm dtirtlnai to festivali �afdM—*s°r ftwee we-Eks wider to <br /> M is event. <br /> 14. Completed by. U `- t ' � r'c ;f ` a•r' -a'1 - alL, <br /> Signature TEL- Date <br /> rHealth Pemlrt <br /> b <br /> t RYW dTomeEs <br /> Cutsinp Head 5 �.�� <br /> E t& :ld inr <br /> a4 3 <br /> Fra�ar_Sixe � � <br /> 3 <br /> Booth must be on <br /> f"lyYrood.or a Tarp. .* <br /> - <br /> rR <br /> ... 7 � � StiL �tY+cr R.rsffix �IDd1d1�G } <br /> Can <br /> s ra}tams ate, <br /> .C2ra hsa'*�gm6 Rcnrl Catarvar-mEsr tc `'�• _""G <br /> - ---.- — _-- .-_—.- sp,eystaiesavorrtsGcu'ut <br /> 'I86P, __, l-lazelton Avenue j Stockton, California 95205 j T 209 468-3420 F 209 464-0138 j vNrw.sjgov.orgfehd <br /> FHD 16-02 Page H of 11 Tr=MP FV17NT APP <br /> M19119 <br />