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-:- <br /> - S A N J O A Q U I N Environmental Health Department <br /> .` COUNTY <br /> Greot,n yaws here. <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 T temperature): <br /> ❑ Ice chests T�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 /> OR �' Three compartment sink. <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 12UMP-style soap container. <br /> 13. Names of responsibl persons to be present in booth during all hours of operation: CT <br /> i4c-J� Yi/!: �..v,�► �sYJ u h/cs l���-1� cl' d,l v47� <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 ev nt, <br /> 14. Completed by: L-� �'jGClI.VL I� - <br /> Signature Title Date <br /> S20 Gal_ <br /> Health Permit Hand washwaler <br /> S[emo wlChaffin� <br /> J <br /> Paper Hand Towels <br /> Soap dispenpf;r <br /> Culling Bowel <br /> .58RitIZer GllCkel- <br /> hlaao&waler for <br /> PropanC Stovo Bleach storing vnp og cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> 0 Pfywood,or a Tarp. <br /> Propane Tank <br /> 4 <br /> Al 7..pand Water Rmsa Water Bleach and Water <br /> Garbage <br /> Fire Entlnpuisher <br /> Can <br /> Extra <br /> Walor <br /> I Ice Cooler I 5GaI Hand wash <br /> Extre fca Bags&Food Containers must be Wastewater Container <br /> SSS stored S inches off of the gm�ndf <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 I F 209 464-0138 I www,sjcehd.com <br /> EHD 16-02 Page 8 of 11 0713/17 TEMP EVENT APP <br />