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S A N JOAQUIN Environmental Health Department <br /> C O U I1\1 T Y----___. <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 /> e chests Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> hree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> sol Ion (one tablespoon of bleach per gallon of water). <br /> L—Apetergent, 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 /> VWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> EZ/One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Gaper towels and pump-style soap container. <br /> 13. Names of re nsiblel pers n ,to be present in booth during all hours of operation: <br /> ra'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 erati n. Return original to festival coordinator three weeks Prior to <br /> this event. a e4 d <br /> 14. Completed by: J <br /> Signature Title D to <br /> - 5.20 Gal. <br /> Health Permit Hand wash Water <br /> Sterno w/Chaffing � <br /> Dish I paper Hand Towels <br /> Soap dispenser L <br /> Cutflno Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> O` Plywood,or a Tarp. <br /> Propane Tank ._-_._... _ <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> LIcC00�2r .,,._- �...-.'^— =.".r_...,--a"''„`- S Gal Hand wash <br /> Ex6a(co bags 6 Food Con[ainers mus[be Wastewater Container <br /> stored 6 inches oft oflhe ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 07/3/17 <br />