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S A N I0AQUIN Environmental Health Department <br /> .e. � COUNTY <br /> 1fl. I 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 /> F! Other(specify) <br /> 11. providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR A <br /> 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 responsible persons to be present in booth dune all hours of operation <br /> � v <br /> **Important** M food vendor booths are subject to inspection. Pleas make a copy this application in <br /> Preparation far 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 /> Health Permit 5-211 cal <br /> Stemo wlCheAng l-4and wash Water <br /> Paper I'larld Towels <br /> Soap dspenser <br /> Cutting Bcasv <br /> ,anll2er bucket- <br /> bleaCl$water for <br /> Propane Stave Bleach WAN wiping duths <br /> Booth must be on <br /> N O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> I'rop3n9'a^H <br /> soap and Water Rinse Waler Bleach and Waier <br /> Garbage <br /> Fire Eztmguisher Can <br /> eMtra <br /> Water <br /> Ice Cooler <br /> 5 Gal liantl wash <br /> Etna ice fWs d Food Crnfamors mvsl be Westewatcr Conlemer <br /> shed 6 inches off cal the groundr <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHO <br /> 07r&117 f1Z Page 8 of t t <br /> TEMP EVENT APp <br />