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S A N J 0 A Q U I N Environmental Health Department <br /> - - C UNYti- <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 /> 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 /> X Detergent, bleach,and wiping cloths(cleaning towels), <br /> ub 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 1007(i.e. 5-20 gallon container with spigot)_ <br /> E�Ipne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> E�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 matte 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 /> 'th ev t_ � <br /> 14. Completed by. t - - -- - 6 - - �:13 3-/:2� <br /> Signature Title Date <br /> 5- Gal. <br /> Health Permit re:nwma <br /> swm wfCitialfinr} <br /> Dish P�pCr Fwnd Tar.91; <br /> Scrap dape�ar <br /> C4rbn9 SonfC SUni9LOf CUC1cCb <br /> bkad+3 witar 10f <br /> Propane$tcvt 6CIIC31 SI6nn§ 7ing G1o'�5 <br /> Booth must be OR <br /> Conrrete,Asphalt, <br /> Plywood,or a Tarp_ <br /> Seaaandwa;pr f2irsevleSu 91cea,and W&tcr Garbage <br /> Can <br /> Ne Exl nAu shK <br /> Extra <br /> Walur <br /> Ice Cooler 5 Gat HAM-ash <br /> I f' Fita lea Begs d Food Centac»rs must✓w Wrstnwnte r canta:ner <br /> ' �cred6inchasdloffhegrarrrd! <br /> 1868 E. Hazelton Avenue Stockton, Ca€ifomia 95205 l T 209 468-3420 F 209 464-0138 l www.sjcehd.com <br /> EHO 16-02 Page a of I TEMP EVENT APP <br /> 071WI7 <br />