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SAN JOAQUIN Environmental Health Department <br /> CCU I\,J7V <br /> 10, I 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 ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 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 /> 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. i 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 /> W Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <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. <br /> 14. Completed by. -7 15— <br /> gnature Title Date <br /> 5-20 Gat <br /> Health Permit Hand wash Wator <br /> sterna w)Chaff rQ <br /> Dish <br /> Paper Hand TDwe� <br /> Soap dispenser <br /> r m,ro Board Sander bucket- <br /> bleach S water For <br /> Provane stove Meech storing wrpng cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp <br /> Propene Tevti� <br /> f 'F*" Soap and Water Rtnse Water ptnach am Water <br /> ,� Garbage <br /> Can <br /> Fire Esting"tret <br /> 1r><tra <br /> water <br /> Ice Cooler . 5Gaf Ham W.1 tt <br /> E.tro ks Baps d Food Canramers must he wastewater Conttanat <br /> sn"a 5 mates oN of 101r groathit <br /> 1868 E Hazelton Avenue l Stockton, California 95205 l T 209 468-3420 F 209 464-0138 1 www.sjgov.orglehd <br /> EMD 16-02 Page&of 11 TEMP EVENT APP <br /> n'r 4--A <br />