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Environmental Health Departmenta?}. <br />10 <br />12. <br />'aper towels and pump-style soap container <br />13. <br />’’important” <br />14.Completed by <br />Patxw Hand Twnete <br />SiXH) drUMtns-w <br />BlwdiStow* <br />Proiww <br />Btaar* and Water <br />Fsrs LxIrMiUMUw <br />166SE. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 464-0138 I www.sjgov org/ehd <br />TEMP BVENT APPPage 8 of It <br /> Electric stove top O'Other (specify) <br />meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />EHD tfr® <br />IWW19 <br />5 Gai Hand *aa,t <br />Wmswater (xwtiarww <br />5-20 <br />>WY1 Waf*r <br />flln <br />Wafer <br />5l»mo wrOttWig <br />OWh <br />SwwiarcMeMt- <br />Dtewti a water i&r <br />E&ring wipng doftw <br />SAN JOAQUIN <br />COUNT'Y— <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I www.siqov.orq/ehd <br />f^^gjfg02 Page 7 of 11 temp event app <br />Ocwa < tc <br />Title <br />1 <br />Snap md A ax'.RaiwWatw <br />Booth must be on <br />Concrete. Asphalt <br />Ptywooa, or a Tarp <br />____________ <br />11 lamproviding the following items within my booth tor the sanitary cleaning of food preparation utensil <br />ETThree compartment sink <br />OR <br />i CU ... i <br />U 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 />Ail food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for thjs eventA copy of this checklist must be in the booth at all hours of <br />pretf^ton ai^ Zpey«ignz Return original to festival coordinator three weeks prior to <br />f Signature <br />I am providing the following coki temperature control tor the cold holding of potentially hazardous foods below <br />45^ (if food is used the following day, maintain below 41*F temperature) <br />Ejlce chests Q Refngerator <br /> Refrigerated truck fl Ice bath and tubs <br /> Other (specify)__ ________________ <br />Ice Cooler <br />■— <br />Garbage <br />Can <br />MKMUISMBamaf <br />I f Bjrjs 4 Atxxf COdtamni musi be H <br />| sfbrvJ fl »nch»J off of tfta gntuntfl <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />L<fWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />£y6ne separate tub (bucket or basin) for the coltoction of nnsa'wastcwatcr <br />Names of responsible persons to be present in booth during all hours of operation <br />AilQg-V-TO _ <br />Health Permit <br />^/z z <br />Date