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r <br /> S A N J O A Q U I N Environmental Health Department <br /> -- CUUN-v <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 450F (if food is used the following day, maintain below 41°F temperature): <br /> *Ice chests ❑ Refrigerator <br /> ❑W 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 /> ❑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 /> 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 /> XOne 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 /> "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: <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash water <br /> Sterna wfChaf inq <br /> nisn <br /> Paper Hand towels <br /> Soap d,spensar <br /> Cutling 8pard Sanitfzer buckel- <br /> hleach 8 water for <br /> Propane Slove <br /> Bleach storing wiping Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood, or a Tarp. <br /> PmoH ne Tank <br /> Soap and Waler Rinse sler Bleach and WM., Garbage <br /> Can <br /> Fire E4ing,a5her <br /> Extra <br /> Water <br /> Ice Cooler 5 Gat Hand wash <br /> Extra doe Fags 6 Food CMMeifers must be Wastewater Container <br /> ' slarsd 6 f/,dws off of fha grotrW <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06/19119 <br />