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S A N 3J 0 A Q U I N Environmental Health Department <br /> Iit `� --COUN 7`! <br /> '0. 1 am Droviding the following cold temperature control for the cold holding of potentially hazardous foods below <br /> -=;:*F(if food is used the following day, maintain below 41°F temperature): <br /> Ice chests ❑ Refrigerator w�� <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 /> n Three compartment sink. <br /> OR <br /> IK Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> olution(one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths(cleaning towels). <br /> P}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 /> N Water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> In One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> VS Paper towels and pump-style soap container. <br /> 13. Names responsible persons to prQs tt in booth during all hours of operation: <br /> **Important** All food vendor booths are subject to inspection. Please make a copy of this application Iri <br /> preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> Dreparation and operation. Return original to festival coordinator three weeks prior to <br /> this,event. <br /> 14. Completed by: (N �k <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Stemo w/Chaffing _ <br /> uish Paper Hand Towels <br /> 1 Soap dispenser <br /> Cutting Board Sanifizer bucket- <br /> Weach&water for <br /> Propane Stove <br /> Bleach storing wiping doths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> LF <br /> .y Plywood,or a Tarp. <br /> Propane Tank - <br /> Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Can <br /> Fire Extinguisher <br /> F_xtra <br /> water <br /> Ice Cooler 'g i +' 5 Gal Hand wash <br /> Extra Ice Bags B Food Containers must be Wastewater Container <br /> stored 6 inches off of the groundt <br /> 1868 E. Hazelton Avenue , Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> )7/3/17 <br />