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SANAOAQUIN 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 day, maintain below 41 IF temperature): <br /> XIce chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 1 1. I 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 /> so tion (one tablespoon of bleach per gallon of water). <br /> (Detergent, bleach, and wiping cloths (cleaning towels). <br /> ❑ 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 /> ❑Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub (bucket or basin) for the collection of rinse/wastewater, <br /> XPaper towels and pump-style soap container. !! �10r 133 10 <br /> 13. Names of r sponsi le person to be present in bK <br /> th during all hours of operation: 1� 2 <br /> r 1 <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. Return original to festival coordinator three weeks prior to <br /> this a nt. <br /> 14. Completed by: Z <br /> Signature —it le Dat I <br /> 5-20 Gal <br /> Health Permit Hand wash water <br /> Sterne wlChaffirr, <br /> Dish <br /> L I <br /> Paper Hand Towels <br /> Soap dI5P9rSer <br /> Cctdng Bowe Sanifizer bucket- <br /> blearh 8 water for <br /> propane Stove Bleach storing wiping Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane lank " <br /> Soap and Water Rinse Water Bleach ar Water <br /> Garbage <br /> Fire Exlingw5har Can <br /> E nra <br /> dater <br /> i Ice Cooler 1 Sol 5 Gal Hand wash <br /> Extra Ice Bags&Food Confa+ners must be Wastewater Container <br /> stored 6 inches off or fhe grcuna! <br /> 1868 E. Hazelton Avenue 1 Stockton California 95205 1 T 209 468-3420 1 F 209 464-0138 1 tnfww.sjgov.org/ehd <br /> EHD 16.02 Page 8 of 11nr 1.I'll TEhfP EVENT APP <br />