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S A N.-10 A Q U I N Environmental Health Department <br /> C COUNTY <br /> Greatness grows here. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45OF(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 /> 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 /> 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 rinselwastewater. <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 /> j)ebQrah Shepard_ Marium Shepard <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: <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Ste HandwashWater <br /> Sterne wfChaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanifter bucket- <br /> bleach&water for <br /> Propane stove <br /> Bleach storing wiping Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank — — � <br /> k Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> k Fire 6dinguisher <br /> ' € Extra <br /> E Water <br /> Ice Cooler 6 Gal Hand wash <br /> Extra ice Bags&Food Containers must be Wastewater Container <br /> stored 6 inches off of the ground! <br /> 1868 F. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 ( www.sjgov.org/ehd <br /> EHO 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06119119 <br />