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i S AN '10U IJ I N' F1rovironmental Health Department <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 following3�frigerator <br /> maintain below 41°F temperature): <br /> ❑ Ice chests <br /> 5ZEWrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I W 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 /> 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 wamn 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 rinselwastewater_ <br /> Paper towels and pump-style soap container. <br /> 13. Ngmes of r sponsible pMU <br /> e present in booth during all hours of operation: <br /> -UV itkCc'\ <br /> "*Important" All food vendor booths are subject to inspection. Please make a copy of this application in <br /> prepar on for this event. A copy of this checklist must be in the booth at all hours of <br /> I <br /> and ration. Return original to festival coordinator three weeks prior to <br /> his �j� Q q <br /> 14. Completed by: �^ <br /> Signa ure Title Date <br /> 5-2U Gal_ <br /> Health Permit <br /> Sterna wJChafruep <br /> Qish <br /> Paper Hand Towals <br /> Soap dispenser <br /> CutiinV Guard Sanluzer bucke!- <br /> bleach&water for <br /> Propana Stove Bleach s:onng vdping(i.11)s <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap anU Waler Rinsc•i`hlnr Bleach and Walef Garbage <br /> Can <br /> Fire Exlirauisher <br /> Extra <br /> Nlalrrr <br /> Ice Cooler 5 Gal Hnndwash <br /> Exlr Ice Bags&Food Conlaeors roast be Waslewal©r Container <br /> stared 6 inches oft of the 9wo <br /> 1868 E. Hazelton Avenue I Stockton, California 95 ' =68-3420 F 209 464-01:i; I wvvvv.sjgov.org/-rig; <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 68H9119 <br />