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S A N J O A Q U I N Environmental Health Department <br /> --COUNTY <br /> �:reotness grows 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 OF temperature): <br /> ❑ Ice chests 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 <br /> �A 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 pump-style soap container. <br /> 13. Names of responsibl persons to be present in booth during all hours of operation: <br /> W i9 s+- //))a s✓cs tz <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: [ow'('V'5�r2 <br /> Signature Title Date <br /> ' 1S <br /> 5-20 Gel, <br /> Health Permit Hand wash Walar <br /> 51emo wlChaPfing <br /> �Ish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cullinq Soard <br /> san,tizer bucket- <br /> bleach&water for <br /> Propane Slovp Bleach sloring wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Q` Plywood,or a Talp. <br /> Propane Tank <br /> snip and Water Rinse Water Bleach and Water <br /> Garbage <br /> Fire Exllnquishnr <br /> Can <br /> Extra <br /> Water <br /> Ice Cooler 4 5 Gal Hand wash <br /> I Ll- <br /> �61 <br /> ags 8 Fooe Cater Carlainer <br /> ches prf dl the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 J F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 0713117 TEMP EVENT APP <br />