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N Q ( N Environmental Health Department <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°F temperature): <br /> ❑ ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck Weez(t�l <br /> bath and tubs <br /> 14 Other(specify) C-1111 i 1A�f #�� J C 7 . <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 /> JZ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solution (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 /> LP <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 r nselwastewater. <br /> Paper towels and pump-style soap container. <br /> 13. rc <br /> s of responsible persons to be present in booth during all hours of operation: <br /> n1 ') C.f_-)K0 12 <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 event. f <br /> 14. Completed by: (� '� Cuej'l.�Oct;'C�l �'y / ' C 2['2% <br /> Signature Title Date <br /> 5-zo ca. <br /> Health Per <br /> 9erno w'C.^.a'Lng - <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutbnq Board 5anrLzerhurkel- <br /> hlaa�B—ler for <br /> Propane Slova 61ea�h slo7ng vrpng Goths <br /> Booth must be on <br /> D Concrete,Asphalt, <br /> Plywood, or a Tarp. <br /> Prowno Tank <br /> Soap an6 Waiet RVnsewaler &each and Wa'.er Garbage <br /> Can <br /> Fire Exunpulsner <br /> E KSn <br /> Wnler <br /> Ice Cooler 5GalHandwash <br /> �y foi ggps d FOOd Cpptgg �bo WnSlanaler Container <br /> ' - -- --- gorod G A�Moa offal Me prounar <br /> 1868 E. Hazelton Avenue Stockton. California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHo 16.02 Page 8 of 11 TEMP EVENT APP <br /> 0 710 112 02 4 <br />