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SKJOQQ N Environmental Health Department <br /> �..�-f�f —COUNTY--- <br /> y�o�,� e•r.�,7P55 Qr�n•5 �r';P <br /> 10, 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457 (if food is used the following da , maintain below 417 temperature): <br /> 2Ice chestsRefrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. Iproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br /> hree 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 /> �etergent, 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 /> 00ne separate tub (bucket or basin) for the collection of nnselwastewater. <br /> Paper towels and pump-styie soap container. <br /> 13. Names of responsible per ons to be present in booth during all hours of op ration <br /> 2� 7i(1G( <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 fes 'yal coordinator three weeks I prior to <br /> this eve <br /> 14. Completed by: 141�q <br /> ign Title Date <br /> 5-20 Gal <br /> Hantl wash Water <br /> Health Permit Stemow/ChafSng <br /> Dish Papef Hand Towels <br /> 508t]df5penser . <br /> sanrhxer ducket- <br /> CuriN Boar C Neacn d water for <br /> storirg vdprng cloths <br /> Bleach <br /> Propane stove <br /> � Booth must be on <br /> Concrete,Asphalt. <br /> i � Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and water Rinse water BleaUi and'water Garbage <br /> Can <br /> F,re Ex incu sh er <br /> E ztra <br /> law— <br /> Wdte <br /> f1ce <br /> t✓OO B r 5 Gel Hand wash — <br /> l•+ Wastewater container <br /> Extra fee 3895 5 FpOC Gonfabner5 must <br /> $forgo 6 Niches off of the ground' <br /> 1868 F. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 f www.sjgov,orglehd <br /> ❑ono R of 7 1 TEMP EVENT APP <br />