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SA N !O A Q U I N 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'F temperature): <br /> ❑ Ice chests ❑ Refrigerator A1/4 <br /> ❑ Refrigerated 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 ❑Three compartment sink. y // <br /> ❑ 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 /> �J Water supply dispenser with warm water at a minimum of 1007 (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> ] Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation. <br /> M r �w(i s <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 peration. Retunn original to festival coordinator three weeks prior to <br /> this event. <br /> L�1, <br /> 14. Completed by: <br /> Signature Title Date <br /> uc-; 3p '• S.r-,^r 5-20 Gal, <br /> Health Permit = Hand twdsh Water <br /> Siemo wlChaffing <br /> Dish <br /> Paper Hand Taweln <br /> Soap d;5eenaer <br /> Culttrp 8aard Sanitizes b ckat- <br /> bleach d crater for <br /> Proi>ane Slwe Bleach storing wiping cleths <br /> _ Rcasat Fi muot be on <br /> Concrete,Asphalt, <br /> i U''1 Plywood,or a Tarp. <br /> Propane lank <br /> Soap and walB[ Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire EonpuiSfm <br /> E>Rra <br /> VJatm <br /> Ice J — <br /> Cooler 5 Gal FFantl wash <br /> Edra Ice Bays d Food Containers must be wastewater Con ainer <br /> -- stared 6 itches ofrof the ground' <br /> 1868 F. Nazelton Avenue l Stockton, California 952051 T 209 468-3420 t F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 16-02 Page 8 of 11 TEMP EVENT APP <br /> 011919 <br />