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SAKdOAOUIN Environmental Health Department <br /> ----COUN—Y <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 da , maintain below 41°F temperature): <br /> ( 0 chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> ❑ Other(specify).._____ <br /> 11. 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 /> 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 /> E�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 /> Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> I!t ti G L� <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 aration. eturn original to festival coordinator three weeks prior to <br /> this eve t. <br /> 14_ Completed by: <br /> �— Signature Title Date <br /> 5-20 Gal <br /> Health Permit Sle Hand wash Water <br /> mc wlCnafring <br /> �iah <br /> Papa'Hand Towels <br /> Soap tllsoansar <br /> Cutting Beartl Senil¢er bucket- <br /> hleach S waterfor <br /> Bleach alonng wiping cloths <br /> Prn9ane Stovo <br /> Booth must be on <br /> Concrete,Asphalt. <br /> Plywood.or a Tarp. <br /> Propene Tank <br /> Soap and Water Rime Wnte+ Bleach and Water Garbage <br /> Can <br /> Fua Extinpusher <br /> Exlra <br /> Wale' <br /> Ice Cooler I 5 Gal Hand wash <br /> Extra Ice Bags d Food Contamera must be Wastewater ConSeinrr <br /> ----- slored 6 inches off or the ground' <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EKD 1"2 Page 8 of 11 TEMP EVENT APP <br /> 07l0112024 <br />