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SAN 1 U A U 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 IVO ernrr c bie as honey is <br /> [I Ice Chests [] Refrigerator M� <br /> ❑ Refrigerated truck ❑ Ice bath and tubs prepackaged according to Cottage <br /> [-] Other(specify) Food requirements- <br /> 11, <br /> e uirements .11, i am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑ Three compartment sink. <br /> OR <br /> L] Three deep tubs (basins 6-8 inches minimum), one IV of as w�r qnq f ains*bne onefora bleach <br /> solution(one tablespoon of bleach per gallon of water). IV a3p y <br /> F-] Detergent, bleach, and wiping cloths(cleaning towels)prepackaged according to Cottage <br /> L-[ Tub to store wiping cloths in bleach solution. <br /> Food requirements <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> DQ 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-st Ie soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> LuisLuts Elizondo <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: <br /> Signature Title Date <br /> S-20 Gal <br /> Health Permit + 'dwaslt water <br /> s[ema wtChaffa�g <br /> ui� Paper Bend Towels <br /> SPNV tl18VOn8gr <br /> Luling ward 5aniazar blrckel- <br /> Ghearh 6 water ter <br /> Etloarh stonng mpnp doths <br /> Propane Stave <br /> Booth must be on <br /> O Concfote,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane lank <br /> Soap and Water Rinse Wzter Ireach and water Garbage <br /> Can <br /> rim t Monfnnsher <br /> rare <br /> Wates <br /> Ice Cooler 6Gai 11and wash <br /> Extra ko flags 6 t-pod Gotuanars must be Wastewater C.0111alner <br /> stored 6 errc'hes aft of the ground, <br /> lAazellon Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464.0138 1 vwwv sigov orglehd <br /> END 16.02 Page 8 d 11 TEMP EVENT AFP <br /> OWS12o27 <br />