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Q, <br />SAN JOAQUIN Environmental Health Department <br />Greatness <br />grows here. <br />10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45'F (if food is used the following day, maintain belo 41 eF temperature): <br />.Ice chests efrigerator %f�11t <br />❑ Refrigerated truck ❑ Ice bath and tubs <br />❑ Other (specifv) <br />11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />❑ 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 />so ution (one tablespoon of bleach per gallon of water). <br />etergent, 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 responsible persons to be 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 />preparatiog—ainthoperation etum ori final to festival coordinator three weeks Prior to <br />this event. <br />14. Completed by: WA14a� <br />S ature Title Date <br />szh Gel. <br />Health Permit Hantl wash weW <br />Slemo w/Chalrvp <br />aleh <br />Paper Hantl Towels <br />Soap tllapenser <br />CUWng Boen1 SanPomr buckel- <br />bleach 8 cooler for <br />Pmpana Slava <br />aleeW storing wiping doau <br />Booth must be on <br />Concrete, Asphait, <br />...,; .. , Plywood, ora Tarp. <br />Propane Tank <br />Scrap and Wabr Rinse Water Bleach SME-t-] <br />ntl Water Garbage <br />� an <br />Flre etllnWleher <br />f etlre <br />d Water <br />IGe C00�2r <br />W1 Gal Hand= <br />Ewe Ice Begs d Food CoMainen must be Wastewater ConWner <br />atoled 6Inches of of the gmundl <br />1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.sjcehd.corn <br />EHo 79-02 Pege9of l7 TEMP EVENT APP <br />07/3117 <br />