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-4 <br /> SAND OAQ U f N Environmental Health Department <br /> COUNTY-- <br /> GI"ls7tnESS r0'✓✓S hel'E. <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 /> ❑ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) ri1A <br /> 11. l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> t4 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 /> ,Paper towels and um -st le soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> W %%-%-►kN r ti G A 9-0 1.3 ea- <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: Low, 0 '" #4 CC 17- t° I ZS <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Handwash Water <br /> Sterno wlChafrirg <br /> Dish Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Stave <br /> storing wiping cloths <br /> 8feach <br /> Booth must be on <br /> Concrete,Asphalt, <br /> J:� '�' Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> t Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> �Ce CoG�Dr 5 Gal Hand wesh <br /> Extra!te Bags&Food Contalners must be Wastewater Container <br /> stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 ( 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 /> 06119f19 <br />