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SANsd0A0UIN p <br /> .� •-�- :- Environmental Health Department <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 P5Ice bath and tubs <br /> ❑ Other(specify) D _e r i� I <br /> 11. I am,piloviding the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Bkthree 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 /> s lut' n (one tablespoon of bleach per gallon of water), <br /> argent, 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 100°F (i.e. 5-20 gallon container with spigot). <br /> �ne separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> aper 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 make a copy of this application in <br /> prep ration for this event. A copy of this checklist must be in the booth at all hours of <br /> pre oration and operati n. Return original to festival coordinator three weeks prior to <br /> evgm, t��t, -�r 3/ 2�- <br /> 14. Completed by: <br /> Signs ure Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash water <br /> Sterna wlChaffing <br /> E}sh <br /> Paper Hand Towels <br /> Soap dispense <br /> Cutting Board Sanitiaer bucke[- <br /> bleach 8 water for <br /> Propane Stove <br /> Bleach storing wiping Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Soap and Water 12inse Water Bleacr,ana Water Garbage <br /> Can <br /> ."� 'E'er' Fire Extinq�i5her <br /> ffce Cooler 5 Gal Hard wash <br /> EXfre ice Bags&Food Containers rn 15e Wastewater Container <br /> stored 6 rncnes off of the ground' <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 ( F 209 464-0138 1 www,sjgov.org/ehd <br /> FHn 1 fi.117 Page 8 of 11 TEMP EVENT APP <br />