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SAN 10AQUIN Environmental Health Department <br /> —COUNTY <br /> Cr, olrlrst5 Crniv: lirrr. <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 followin da 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 /> ❑ 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 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 /> "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 /> reparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. / <br /> 14. Completed by: 4L n /� 1 �� Owner 4-10-2026 <br /> Signature Title Date <br /> 5.20 Gat. <br /> Health Permit Nand wash water <br /> Sterna w!Chatttng <br /> Dish <br /> Paper Hand Towels <br /> Soap tlispenser <br /> Cutting Board Sanitizerbuckel- <br /> 1\ <br /> bleach&water for <br /> Propane Stowe <br /> Bleach storing wiping Goths <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 /> Ice Cooler 5 Gal Hand we <br /> Extra Ice Bags&Food Containers most be Wastewater Container <br /> stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 1 www.sjgov.orglehd <br /> EHO 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06/19/19 <br />