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SAN 2,10AQ U I N Environmental health Department <br /> --COUNTY— <br /> Greatness grows hefc. <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 4VF temperature): <br /> M ice chests ❑Refrigerator <br /> ❑Refrigerated trick ❑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 /> ff"W"ater supply dispenser with warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot), <br /> [�kbne separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> [gaper towels and Rmp1tvle soap container. <br /> 13. Narus of esponsi ors o be present in booth during all hours of operation: <br /> 1."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 a peraG n. turn original to festival coordinator three weeks prior to <br /> thl aril. — a a� <br /> 14. Completed by: <br /> Signature Title iota <br /> sxa car <br /> Health Permit HaM waM w.r.r <br /> o.An <br /> Papve H.nd[or..e <br /> 1GoA0 vP.M1w <br /> C,aafiu Nv+d San,W.r Dyele.l <br /> G6ed.8 wain far <br /> Plow*SWN Spat l '0-P-V dathA <br /> Booth Inual be on <br /> Concrete,Asphan, <br /> Si�ri Y Plywood.or a Tarn. <br /> Pro"" <br /> n se.Pr W.W --I'+w. &..r1,r.tW.I.r � GaroagB <br /> Can <br /> F.v 11 mnw Ww <br /> ExY. <br /> WVW <br /> (Cie Cooler SONSIAM4 *sM <br /> E+VI k.fts 8 Food Ceradl.rl MS[O. W urnw.tar Conun.r <br /> �Wvd 6#9%l CrrOrM V%Mdl <br /> 1868 E.Hazelton Avenue I Stockton,California 952051 T 209 468-3420( F 209 464-0138 j www.sjgov.org/ehd <br /> EkD 16-02 Page B W 11 TEMP EVENT APP <br /> Ofi IVIS <br />