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i <br /> S KJ O AQ U I N Environmental health Department <br /> --COUNTY <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, main in below 41 OF temperature): <br /> ❑ Ice chests rigeretor <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. 1 am prgxiding the following items within my booth for the sanitary cleaning of food preparation utensil <br /> fee 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 /> ❑T ub 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 /> li,.VAr supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br /> Wl a separate tub(bucket or basin)for the collection of rinse!wastewater. <br /> Wf'aper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> l.-)ri Y� "ror)se g.... <br /> * Imr,orta pt' All food vendor !moths are subject to inspeCtinn. 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 nd oper ion. Return original to festival coordinator three weeks Prior to <br /> thi J� l2 ,�Z / <br /> 14. Completed by: <br /> Signature Title Date <br /> 5-20 CA. <br /> ..f.v�. Hand wash water <br /> Health Permit <br /> Stern w/Chaffing <br /> Dish Paper Hand Towels <br /> Soap dispenser <br /> Sanitizer bucket- <br /> Cutting Board <br /> bleach&water for <br /> storing wiping cloths <br /> Propano Stove Bleach <br /> Booth must be on <br /> Concrete,Asphalt, <br /> 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 /> fce Cooler 5 Gal Hand wash <br /> Extra Ice Sags 8 Food Containers must he <br /> Wastewater Container <br /> stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue 1 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 TEMP EVENT APP <br /> 06/1cl 19 <br />