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S A N. J Q A Q U I N Environmental Health Department <br /> cnu�1; � 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 /> ce 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 /> tI in(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 100°F(i.e.5-20 gallon container with spigot). <br /> XOne separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> LAaper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of op ration: <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. Retum original to festival coordinator three weeks prior to <br /> this event. �n <br /> 14. Completed by: <br /> i natu Title bafe <br /> '.' t"; ��'ii;`?y: 5-20 Gal. <br /> ,s. Hand wash W ater <br /> Health Permit R <br /> Stemo w/chatTirp T—I <br /> Dish Paper Hand Towels <br /> Soap dispenser <br /> Sanlrizer bucket- <br /> Cutting Board bleach&water for <br /> storing wiping doths <br /> Bleach <br /> Propane Stove <br /> Booth must be on <br /> Concrete,Asphalt. <br /> ooi <br /> Plywood.or a Tarp. <br /> Propene Tank <br /> Soap and water Pinsewater Bleach and Water Garbage <br /> Can <br /> Fire Extinquisher r <br /> 6rlra t <br /> /�� Weter {tf <br /> Ice COOlBf ti.2tTaV+Y�7:3AGii4S�iftKsfi(a^�t31iF�l' scaii�anawash <br /> ' Container <br /> ke Bags&Food Containers must be Wastewater <br /> _.. ..........._.: stored 6 inches of orthe grrxmd! <br /> 1868 E. Hazelton Avenue! Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orq/ehd <br />