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SA N J O AQ U I N Environmental Health Department <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 /> ® 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 /> X 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 /> X 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 rinselwastewater. <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 /> Mishacl Moran <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 rior to <br /> this event. <br /> 14. Completed by: Mishacl Moran Owner 6/10/2024 <br /> Signature Title Date <br /> 5.20 Gal <br /> Health Permit Hand wash Water <br /> Stemo wlCharFlng <br /> O+sh Paper Hand Towels <br /> $pap 1115(IBn50r <br /> Cumng Board $anivaer bucpel- <br /> oleach 6 water for <br /> Propane Stove Bleach storing mpmg ciD <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood.or a Tarp. <br /> Prppane Tank <br /> Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Can <br /> Fire Ext,nrluraher <br /> Extra <br /> water <br /> ice Cooler 5 Gal Ham wash <br /> Ewe ice BAQS B PoW Confemars must be Wastewater C Qntainer <br /> -- - sforad 6lnches off of 1ha gmunill <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713/17 <br />