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SAN 10 A Q 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��11 ❑ Ice bath and tubs <br /> L]Other Other(specify} e. <br /> 1U-tdtIi c F' pti►o�i/7tt' 1x-gyp P/l..cNi e- L <br /> N �91, 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 /> N)I112. I 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 100aF(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 soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> t]t,ua.t 1 1 <br /> �l&>n t-k! -:�, k 6 a,," <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 vent. /� <br /> 14. Completed by: t! 4 <br /> 0 Signature Titli pate <br /> 5.20 Gal <br /> Health Per hand wash water <br /> Sterno wlChaffng <br /> Dish <br /> Paper l land Towels <br /> soap dsponsar <br /> (;ulhnq ESoard Sandirer buc)(el- <br /> bleach&wafer <br /> or <br /> slonng wpmclolhs <br /> Yr�arm Stove Bieacl� <br /> oo <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> soap a w water RYne wyicr Rleach arxl water Garbage <br /> Can <br /> Fire Fatngtssh« <br /> F.Hlra <br /> Water <br /> Ice Cooler 5Ga1Ilandwash <br /> Fits ke Bays 6 Food Comamers must J>e it Wastewater Container - <br /> stored 6 rnGhes oRof the ground' 'i <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> F_HU 16-02 Page 9 of 11 TPMV F_Vr:N I APP <br /> 0713!17 <br />