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ryl SA N ) QAQ N Environmental Health Department <br /> - <br /> .-- ---COUNTY <br /> 10 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 450F (if food is used the following day, maintain below 41°F temperature): <br /> E 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 /> 0 Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> sol tion (one tablespoon of bleach per gallon of water). <br /> [+]Detergent, bleach, and wiping cloths(cleaning towels). <br /> Ej,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 /> P Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> 0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> P�Paper towels and pump-style soap container. <br /> 13. Names of esponsible persons to be present in booth during all hours of operation: <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. urn original to festival coordinator three weeks prior to <br /> this ev <br /> 14. Completed by: �� �� <br /> Signat re Title Date <br /> - -- -- - 5-20 cal <br /> Hand wash MierMealth Permit <br /> 8larna wlChatfirq <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> cutting Board Sanitizer bucket- <br /> bleach 8 water for <br /> Propane Stove <br /> storing wiping cloths <br /> Bleach <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> P,w)ane rank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Exllnpuishef <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags 8 Food Containers must be Wastewater Container <br /> stored 6 inches off o1 the ground! <br /> 1868 E. Mazelton Avenue I Stockton. California 95205 1 T 209 468-3420 j F 209 464-0138 � www.sjgov.org/ehd <br /> EHD 1"2 Page 8 of 11 TEMP EVENT APP <br /> GWO112025 <br />