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V- <br /> S A N S OA Q U I 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 /> ce chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) lrfzt- <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ED-rhree 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 /> solo n (one tablespoon of bleach per gallon of water). <br /> &b <br /> e argent, bleach, and wiping cloths(cleaning towels). <br /> 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 /> 2-6ater supply dispenser with warm water at a minimum of 100°F (i.e.5-20 gallon container with spigot). <br /> EA,C�n—e separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> 215aper towels and pump-style sow 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 /> preparati for t event. ?copy f this checklist must be in the booth at all hours of <br /> prep an and er io , etur on final to festival coordinator three weeks rior to <br /> tM vent. - <br /> 14. Completed by: Qu��iA - �ZS� <br /> Signature Title Date <br /> Gal. <br /> Hand wash Vraler <br /> Health Permit <br /> L <br /> L-1-- <br /> lChatfing <br /> Paper Hand Tawels <br /> Soap dispenser <br /> .Sani liter buckal- <br /> Cutfinp Board Dleadr 8 wafer 1ar <br /> Bluing wiping deths <br /> 9leach <br /> Propane Stove <br /> Awlh must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane?enk <br /> Soap erxi Water R,nsa YJntar Bleach and Water Garbage <br /> Can <br /> Fan Fxtinpuishot <br /> Cxcre <br /> Water <br /> Ice Coolerr .: - 5 GBI Mend wart+ <br /> Extra Ice Bags$Food Containers must be <br /> 6Yaslewa[er Gan[einar <br /> - - stored 6 kichas M of the graurd, <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> END 16-02 Page 8 of 11 TEMP EVENT APP <br /> OM112Q24 <br />