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SA N J OAQ U I N Environmental Health Department <br /> — COUNTY— <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 da aintain below 41'F temperature): <br /> El 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 /> so <br /> hree 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 /> ❑.D'etergent, bleach,and wiping cloths(cleaning towels). <br /> 0 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 /> O Water supply dispenser with warm water at a minimum of 100"F(i.e.5--20 gallon container with spigot). <br /> [_— dne separate tub(bucket or basin)for the collection of rinsetw@stewater. <br /> S,P6per towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth_during all hours of op ation: <br /> b\ 1a <br /> t r <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 this ev and operation. Retum original to festival coordinator three weeks rior to <br /> t`' <br /> 14. Completed by: <br /> 5 aturTitle Date <br /> d20�. <br /> Health Permit Hanwash walar <br /> stoma wlChamng <br /> Dish <br /> Paps Nang Towel_ <br /> Scrap dispenx_r <br /> ���BOA SenYlxar hucRet <br /> bleach 6 Wa:or far <br /> Ptnpane Slova Bleach sloMp Aping clmhs <br /> Booth must be on <br /> 0 Concrete.Asphalt, <br /> Plywood,or a Tarp. <br /> Pmpan■Tank <br /> soap and wmer Mrtso waler Bte■rn one wow GBfbage <br /> Flre Ex1r9Wsh■r Can <br /> C-�tn <br /> wm■r <br /> Ice Cooler �I 6GM Fdana wash <br /> EUM Ice Begs 6 FOW Conjdk e=must be waslaAmt■rcnnfaln■r <br /> s!7d d hides off orlhe grwnd! <br /> 1868 E. Hazelton Avenue Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> END 1Cr02 Page Bog 77 <br /> 07rV17 TEMP EVENT APP <br />