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S A N J O A Q U 1 N Environmental Health Department <br /> _C0UN+V__ <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 /> AIce chests ❑ Refrigerator <br /> --e-Refrigerated truck ❑ Ice bath and tubs <br /> —Iffdther(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. 111�� ��I C 7 L'7.0 pW 1:6C k,��t'L� <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 /> _*Dater 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 /> C <br /> , . t <br /> ❑ Paper towels and pump-style soap container. �! � ,� I I -F_,z-� 17)c� xU ' <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: `� t/ (INX)l k IL ��1� f 2- <br /> Sig-nature Title Date <br /> 5-20 Gal. <br /> Hand wash Water <br /> Health Permit <br /> Stemo wXhaffng <br /> alsh Paper Hand Towels <br /> Soap dispenser <br /> Culling F3pard Sanitlzer bucket. <br /> Bleach <br /> bleach&waler for <br /> storing wiping doths <br /> Propane Siove <br /> Booth must be on <br /> Concrete,Asphalt, <br /> O - Plywood,or a Tarp. <br /> Propane Tank <br /> ,kz Soap and Water Rinse aler Bleach and Watcr Garbage <br /> Can <br /> Fire Extin9uksher <br /> Exlra <br /> water <br /> r1ce C0Oler �. 5 Gal Hand wash <br /> Extra Ice Bags&Food Contalners must be Wastewater Container <br /> -- -- --- --—-- stared 6 inches ofl of the ground! <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 TEa1P EVENT APP <br /> 06119,19 <br />