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S A N 10 A Q U I N Environmental Health Department <br /> . COUNTY------- <br /> Greotress qrows Mere, <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 OF 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 /> XThree 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 rinse/wastewater. <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 /> N(-�i0Lre hICsz <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. p <br /> 14. Completed by: �j o A(a l� D 1 R L CT 0 tZ -)9/1y ao 17 <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Per Ste Hand wash Water <br /> mo wlChaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Stove <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> . ........ �rx�� '' Plywood,or a Tarp. <br /> Propane Tank <br /> -a,pryVPryii" Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Can <br /> Fire Extinquisher <br /> Extra <br /> Water <br /> Ice CooleP 5GalHandwash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> -- stored 6 inches off of the ground! F <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 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 /> 07/3/17 <br />