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SA N J OA Q U f N Environmental Health Department <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 /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> 14 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 /> Water supply dispenser with warm water at a minimum of 100pF (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 of responsible persons to be present in <br /> -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 ev ntnt. <br /> Zf' <br /> 14. Completed by: �i'lnn,nl Ili �i,L�� ( ; J - <br /> Signature Title Date <br /> +}a.ia. ,r•,yg atrctWa�.:.?n"ti;`af:i,; 5-20 Gal <br /> Hand wash Water <br /> Health Permit <br /> Slerno w/Chaffing <br /> Dish Paper Hand Towels <br /> Soep dispenser <br /> Sanitize'bucket- <br /> Cutting Board bleach&water for <br /> storing wiping Goths <br /> Bleach <br /> Propane Stove <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane-rank <br /> Soap and Water Rlnse Weler Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> EMra <br /> Water <br /> Ice Cooler ' kit � ''�i' `;SF;n:9 ?: xti'e'e''Y;"Fi 5 Gal Hand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> stored 6 inches olr of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 I wwW,sjcehP.comTEM EVENT APP <br /> EHD 16-02 Page 8 of 11 <br /> 07/3117 <br />