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2092396131 12:21:50 p.m. 06-29-2018 3/3 <br /> SA N J 0 A Q U I N Environmental Health Department <br /> COUNTY-- <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°F temperature): <br /> .�Q Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> Other(specify)_ Se-rve, M0,c V,ih 4 <br /> 11. 1 am providing 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 /> etergent, bleach, and wiping cloths(cleaning towels). <br /> ub 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 100aF(i.e.5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> APaper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Saner TCLP t) <br /> �p Ffnrv>a l !. <br /> **Important** All food ve or 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 eveniL <br /> 14. Completed by:-V I ?'� <br /> QWjt� 2 �� <br /> Signatur Titte ate <br /> S20 Gel. <br /> Health Permit L <br /> owirth walar <br /> stemo wlChaRrg <br /> Dish <br /> Paper Hand Toxek <br /> Soap dhpenxr <br /> CuMhq Board <br /> Sanillzor bueket- <br /> Propano Slovc bleach&walerfor <br /> BleeUt aMng wiping Cloths <br /> Booth must be on <br /> Concrete,Asphalt. <br /> Plywood,or a Tarp. <br /> Propane Tenk <br /> Soap and Water Rk a Watn Bleach and Water <br /> ..r Garbage <br /> :`;'' "•"�;" - Flra Exdingul Can <br /> i Wamr <br /> Ice Cooler SGalHmdwwh <br /> Ex&u 1 b Baps&Food C*Ns6rers must be wastewater container <br /> stored 0 lndres W7 of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sjcehd.com <br /> EHD 1 B-02 Page 8 of 11 <br /> 0713117 TEMP EVENT APP <br />