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Y <br /> ii.� � s A N�J o A QU IN Environmental Health Department <br /> �_ `. COUNTY <br /> Greotriess 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 7Refrigerator <br /> maintain below 41°F temperature): <br /> ❑ Ice chests <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I aryproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> OR <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 /> M/Water supply dispenser with warm water at a minimum of 1007 (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 during all hours of operation.- <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: ` bV�fkKiL_ `—(,I ZZ I.;I <br /> Signature Title Date <br /> 5­20 Gal- <br /> Health Per Hand wash Water <br /> Stemo w/Chaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Hoard Sanitizer bucket- <br /> bleach&water for <br /> Propane Sloe Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> h. <br /> Propane Tank <br /> r Soap and Water Rinse water Bleach and wafer Garbage <br /> Can <br /> Fire Extingu,sher <br /> Extra <br /> Water <br /> r <br /> Ice Cooler I' 5 Gal Hand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> - -- - - stored 6 inches off of the groundl <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 li 209 468-3420 1 F 209 464-0138 l www.sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06/19/19 <br />