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U N Environmental Health Department <br /> SAN3J0AQ <br /> .r <br /> 10 I am providing the following cold temperaturea taontrol fin below 41 F old holdl temperature)of potentially hazardous foods be aw <br /> 45a' if food is used the following day <br /> ce chests ❑ Refngerator <br /> ❑ Refngerated 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 /> OR <br /> ❑Three compartment sink. <br /> water. one for rinsing and one for a bleach <br /> ❑ Three deep tubs (basins 6-8 inches minimum), one for soapy <br /> solution (one tablespoon of bleach per gallon of water), <br /> gEMetergent, bleach, and wiping cloths (cleaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adecuate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ith warm water at a minimum of t00eF (i a 5-20 gallon container with spigot) <br /> ❑Water supply dispenser w <br /> ❑ One separate tub (bucket or basin) for the collection of nnselwastewater. <br /> ®Paper towels and um -s a soa container. <br /> 13. Names of respon ible persons to be present in booth during all hours of operation <br /> of this appli�tion in <br /> of this chet must be in the booth at all hours of <br /> preparation fs <br /> ke a <br /> '"important" All food v en or btos tevent.e subject <br /> l cklis <br /> copy Inspection. Please ma dlnator p three weeks riot to <br /> preparation and operation. Return on inal to fes 'va! coot ®2 <br /> this event. / o �— _ i �' <br /> ' <br /> 14. Completed by: itle Date <br /> Si nature <br /> 5•20 Gal <br /> "arc warm Naleu <br /> Health Permit Paper Hana Towels <br /> $SemC wlChafhng <br /> $OaG Crsoenser Saminer borxet- <br /> Waadt&water for <br /> Stonnq w17n9 dotns <br /> Gt.Ru"S BpafC <br /> BIca J' <br /> Prpoane S�ova Booth must be on <br /> Concrete,Asphalt, <br /> plywood.or a Tarp. <br /> t � <br /> P,,)Pane Tarx Garbage <br /> Q�"se water BieaU�ant rater <br /> Soap and wale+ Can <br /> a... Frre Ennawshef LE1a <br /> a:er <br /> [w- <br /> s1crVo ay Ma �ice Cooler 1"�`ar_°"`ane` <br /> Exrra ice Bays d Food Containers r,vst oe fi Inc"es afro!the grcUna' ov.orglehd <br /> 7 209 468-3420 1 F 209 464-0138 www.sIgov.org/ehd <br /> E, Hazelton Avenue Stockton. California 95205^I R r <br /> TEMP EVENT APP <br />