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S A NUJ O AQ U I N Environmental Health Department <br /> —COUNTY----- <br /> ess f] <br /> Greatness rows here. <br /> •-�iiron�=.• <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 M Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) C`,s 2�04!�� <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 soa container. <br /> 13. Names of responsible persons to b present in booth during all hours of operation: <br /> A � 570, - - <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: _ J Gr//t6L--y— Qzw <br /> Signature Title bate, <br /> 5.20 Gal. <br /> Health Permit Hand wash water <br /> Sterno wlchaHing <br /> Mah <br /> Paper Hand Towels � <br /> Scop dlspnnser <br /> Cullirtp Board sanitizer buekel- <br /> hleach&water for <br /> Pr4pana stovo <br /> 81030Voring wiping dolhs <br /> I <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> SOAP And WAlar Rinse Water Bleach and Ovate: Garbage <br /> �a Can <br /> Fire Exun0ulsher <br /> Exfre <br /> Water <br /> flce�CooAler 5 Ga!Hand wash <br /> i1x1ra ice Begs 8 Fwd Containers roust be wastewater Contalner <br /> stored a Innhas off or rho prouMn { <br /> 1 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd ' <br /> EHD 16-02 Pape 8 of 11 TEMP EVENT APP j <br /> 07/0112025 <br />