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SA N J OA Q U I N Environmental Health Department <br /> I � <br /> '!?rsn'.•i"' {.+f{.'r71f11'tii 1JfU4':5 Flr.'r'r. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 4?°F(if food is used the following day, maintain below 41'F temperature): <br /> Ice chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑Ice bath and tubs <br /> [J 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). 1,4 <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 dispenserwith warm water at a minimum of 1009F(i.e.5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinselwastewater. <br /> Paper towels and pu=-styl-e soag container. <br /> 13. Names of rasp isibl <br /> x� person to be pre ant i booth during all hours of operation: <br /> vw , s ` <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.14. Completed by: tG� r <br /> 2 <br /> Signature Title Date <br /> Health Permit HandwuhWalar <br /> Slemo wlChafring <br /> Dish <br /> Paper Hand Towels <br /> &oap disponser <br /> Gulfirrg Board Sadllzer huckat� <br /> bleach&waleefor <br /> Propane 5lovo Bleach sloring wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> ti a Y Plywood,or a Tarp. <br /> propane Tank <br /> -------------- <br /> ,iyr:'y�,7.' Soap and Wslar Mnsn Mar Hlunch and Weler Garbage <br /> Can <br /> FIra Mnp Wier <br /> • E7Afa <br /> Watar <br /> Ice Cooler ;:.,,,,:ai„y;. :a:h..::,z.,u'—T r^-ray._.,.,.,.i'' 5Gal Hand wa5h <br /> 1 FxlrakeSags&F*WG0nla7nars o muslb WaslewaWrConla'ner <br /> --- - -- 4forcd6fnchesoffollhegroandf <br /> 1868 F. Hazelton Avenue j Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcelid,coni <br /> EHO 16-o2 Page 8 of II TEMP EVENT APP <br />