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-��•° SKJOAQUIN Environmental Health Department <br /> COUNTY <br /> p Grp Mtn.=ss vnos here <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 OF temperature): <br /> ❑ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> 9 Other(specify) [ r t'CD <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 /> N 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 /> ❑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 rinse/wastewater. <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names�o�f�responsible <br /> '�persons to be present in booth during all hours of operation: <br /> ��1L1 t\ S <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. Retum original to festival coordinator three week_s__prior to <br /> t v <br /> 14. Completed by: the L <br /> Signature Title a e <br /> 5-20 Gal_ <br /> Health Permit Hand wash Water <br /> Sterno wfCheffing <br /> _\ <br /> Dish <br /> Paw Hand Towels <br /> Soap tlispenser <br /> L 1 <br /> Cutting Board Sanitrcer buckat- <br /> bleach&water for <br /> Propene Stove <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> ^, Plywood,or a Tar}. <br /> Propane Tenk i� <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler I 5 Gal Hand wash <br /> Fzfra Ice Bags&Food Containers must be Wastewater Container <br /> ` stored 6 inches off of the ground? <br /> 1868 E. Hazelton Avenue E Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 J www.sjgov-orglehd <br /> EHD 16-02 Page 6 of 11 TEMP EVENT APP <br /> 06/29/2023 <br />