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= P SA N 10A Q U I N Environmental Health Department <br /> �1A COUNTY <br /> r <br /> Grentness grosv; her( <br /> % 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 /> [—X1 Ice chests ❑ Refrigerator <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 /> ❑ 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 /> 0 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 /> ❑ 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 /> ❑x Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> (dress Amiri <br /> "Important`* All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this went. 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. \i'',ftl0; <br /> 14. Completed by: Owner 03/01/2026 <br /> Signature Title bate <br /> 5-20 Gal- <br /> Health Permit <br /> Sierra wlChaffmg Hand wash Water <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Culling Board Sanitizer hucket- <br /> 1\ <br /> blaach&water for <br /> Propane Stove Bleach storing wiping Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank - <br /> Soap and Water Rinse Water Bleach and water Garbage <br /> Can <br /> Ire EAinquisher <br /> E�aro <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> stored 6 inches oft or the groundf <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0710112025 <br />