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S A N S 10 A Q U I N Environmental Health Department <br /> COUNTY— <br /> `~it, r„ `�r Grcn[nrtis yt ulvs Jtr:• . <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 below 41°F temperature): <br /> 0] Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice 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 /> ❑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 /> 01 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 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-style soap container. <br /> 13, Names of responsible persons to be present in booth during all hours of operation: <br /> Bernard Martinez Monica Archuleta <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 /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event <br /> 14. Completed by: dV' Manager 412212025 <br /> ",'Signature Title Date <br /> 5-20 5l tael_ <br /> Health Permit Hand wadi Waler <br /> tsna wlCttaKtng <br /> Wish <br /> Paper Hand Towels <br /> Soap dspenses <br /> CulCng Elcard Satuli:ar bucket. <br /> bleach&watee for <br /> Propane Stom R— L <br /> storing viong cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Terp. <br /> Alapanp Tank — Garbage <br /> Can <br /> File Extinguisher <br /> Extra <br /> !+ <br /> Water <br /> ice Gaoler 5 Gor Hand wash <br /> &trio to Bags d Food Conlalncrs most be r wastewalef cool-in-( <br /> - -- sfoMd dfeches orf a the groun& <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> END 16-02 Page a or 1 i TEMP EVENT APP <br /> 0713117 <br />