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SAN J OAQ U I 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 /> ❑ Ice chests ❑Refrigerator <br /> ® Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11. l 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 rinse/wastewater. <br /> ® Paper towels and pump-style soap container. <br /> 13. Nm s pf res onsible persons to be present in booth during all hours of operation: <br /> Nm <br /> �uzman <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 9nd operation. Return orinimal to festival coordinator three weeks prior to <br /> this event. Owner 02/03/2023 <br /> 14. Completed by: <br /> Si atu re Title Date <br /> 1 5-20 Gat <br /> Health permit hand wash Water <br /> Slonno wlCharang <br /> ❑yah <br /> Paper Hand Sowels <br /> Soap dispenser <br /> Cutvnq Elbard Sani izef bucket. <br /> bleach&water for <br /> Prepane S[ovc <br /> Bleach staring"ping Goths <br /> Booth must be on <br /> Concrete.Asphalt, <br /> Plywood,or a Ta(p. <br /> Propane rarvr <br /> Soap and Water ninse Water Bleach and Water Garbage <br /> Can <br /> Fife Extinguisher <br /> Extra <br /> Water <br /> j/ Ice Cooler 5Get Hand wash <br /> a kebaps 6 rood Cu faoers tmsf be WastewalerCenta ner <br /> L-�"-' <br /> rcd 6 inches ol1 al the ground+ <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br /> EFIt)16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713117 <br />