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SAN J OA Q U I N Envivo nmenw Health Department <br /> l I ! I <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 ❑-RiWrigerator <br /> ER efrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11, E a roviding the following items within my booth for the sanitary cleaning of food preparation utensil <br /> EJ 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 /> booth7 <br /> ater supply dispenser with warm water at a minimum of 100eF(i.e. 5-20 gallon container with spigot). <br /> ❑One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> Paper towels and Pump-style soa container. <br /> 13. Names of r sponsibie persons to beesent in booth g a11 h urs o Aeration: <br /> i <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 eration. Retur ri inal to festival coordinator three weeks prior to <br /> thEs event. <br /> 14. Completed by. —�G��.0,/� AI•,_ 7.� Z� <br /> Signa Title Date <br /> 5.2U Gel <br /> Health Permit i Hana wa6h Walar <br /> Sloan wiChatMp <br /> Psh <br /> Pspor Hann TOWau <br /> iII Soap n>,penaer __ <br /> Y Culling Bwstl <br /> 1111 SaruSua bucAet- <br /> Propana5l� Bleats a�onng �gcrlalhs <br /> Booth lnust be on <br /> Concrete,Asphall, <br /> Plywood,or a Tarp. <br /> Preparle Tank <br /> Soap aid Wafer R1rts9 Waiar Bleach and Water <br /> Garbage <br /> Etre Cxting,dihel <br /> Can <br /> EMlra <br /> Wafer <br /> lce Cooler 5C'IHOIW; <br /> Exna rce nags d Foca Gonlaign7a mast as I Waslowaler Cerlte� <br /> Slrunr!fi inchna aN N Ilio grounar <br /> 1868 F. Hazelton Avenue I Stockton, California 952o')l T 209 468-•3420 I F 2.09 464-0138 ( www sjcehd.com <br /> Ef IG 16-02 pogo B of 11 TEMP EVENT APP <br /> 0713117 <br />