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S A N 1 OAQ U I N Environmental Health Department <br /> —COUNTY— <br /> :�..w <br /> Erectness f)rCt'S hc^rn- <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 [91'ce bath and tubs <br /> 2-Other(specify) <br /> 11. 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 /> [�fD�tergent,bleach,and wiping cloths(cleaning towels). <br /> LvJ'I'ub 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 /> 0 Water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> E3110'ne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> (T�Paper towels and puma-style soap container. <br /> 13. Nam� so responsible %sons 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 d operation. Return original to festival coordinator three weeks prior to <br /> this ev <br /> 14. Completed by: <br /> Signature Title D� at4 <br /> 5-20 Gal. <br /> Health Perm Slemo wlChaf <br /> it Hand wash Water <br /> fing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanilizer bucket- <br /> bleach 8 water for <br /> Propane Stove Bleach <br /> storing wiping cloths <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 /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler / i 5Gal Hand wash <br /> Extra Ice Sags 8 Food Containers must be Wastewater Container <br /> �a <br /> stored 6 inches off of the ground? <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713/17 <br />