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SAN J O A U U l N Environmental Health Department <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 /> [M 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 /> M 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 /> FXI 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 /> n 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 /> Claudia Hazelwood, Jessica Jimenez <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: TTe erc !(r 1-1(i ?WQ16,661 Owner 1.2128/2023 <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Per Hand wash Watar <br /> Storm wfchaffi <br /> Nish <br /> Pnpor(land Towels <br /> Soap dispansar <br /> Cuomo noard Saniuzer buckat- <br /> bloach d WW*' <br /> fpr <br /> Propane Stovo ❑[oath storing wiping cloths <br /> Booth must be on <br /> ❑ Concrete.Asphalt, <br /> Plywood,or a Tarp. <br /> r'rapano iank <br /> Soap end Wator Rinso Waicr Man and Wator Garbage <br /> Can <br /> Fxo f'rtmawsher <br /> F stra <br /> Walor <br /> Ice Cooler 5Gal Hand wash <br /> FWD!ce flags d rood Confarndrs rnvs!ba Waslewa=er Contain <br /> sfaed 6 Idles dr DIMO grouddr <br /> 1 1 <br /> 18r38 L. I UM1011 AVOMie I Stockton. California 5.`;105 j T 209 468-13+120 1 F "09/164-0138 1 www.sjcehd cam <br /> FHD 16-02. Page 8 of i t TEMP EVENT APP <br /> 07/3/17 <br />