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SA N J UA Q U I N Environmental Health Department <br /> —COUI,,ITY <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(if food is used the following day, maintain below 41"F temperature); <br /> ❑Ice chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑Ice bath and tubs <br /> ❑x Other(specify) NA- prepackaged <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 /> ❑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 /> ❑x Water supply dispenser with warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot). <br /> ❑x One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and puma,-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Kai-Kenny Chew <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: ,y I Co-founder 8R125 <br /> Signature Title Date <br /> 5-20 Gel. <br /> Health Permit Hand Waler <br /> 5[erra wlChrtang <br /> Psn Paper nand Towels <br /> Sg3P drapenser <br /> Gubing Board Sanilizar buckel. <br /> bleach a water!or <br /> Propane Stare gl�pr staring aping dohs <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propene lank <br /> Soap and Water Rinse Water Bleach and Water I Garbage <br /> Can <br /> Fie Estingurshm <br /> EaVa <br /> WplC+f <br /> fce Cooler / 1 SGal Hand mash <br /> Erma Ice Bags 6 Food Containers—Va� Wds:ewater Congrner <br /> - slored 6!aches aft of the 9r ndl <br /> 1868 E. Hazeiton Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Pape 8 of 11 TEMP EVENT APP <br /> 0713117 <br />