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S ,,J OA Q U I N Environmental Health Department <br /> l..) rs ._ <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 /> El 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 /> ❑ 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 /> E� 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 of responsible persons to be present in booth during all hours of operation: <br /> €f191t ovlai lc . i)ulce Donesa-Manto <br /> isa oni/��1;orYa0S. Mikaella Manto <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: O ilce Donesa-Manta May 10, 2024 <br /> Signature Title Date <br /> Health Permit 5-20 Gal. <br /> Sterna w/Chaffing Hand wash Water <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board <br /> Sanitizer bucket- <br /> Propane Stove bleach&water for <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Propane Tank PIyWOOd,or a Tarp. <br /> Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Fire Extinquisher Can <br /> Extra <br /> Water <br /> Lice Cooler <br /> 5 Gal Hand wash <br /> ,- Extra Ice Bags 8 Food Containers must be Wastewater Container <br /> stored 6 ruches oflaf the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjdt�v.OI-q/ehcJ <br /> EHD 16-02 <br /> 06/29/2023 Page 8 of 11 TEMP EVENT APP <br />