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S A N J O A Q U I N Environmental Health Department <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 below4l°F temperature): <br /> Ice chests ® Refrigerator <br /> ❑ Refrigerated truck ® Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am provi6ng 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 rinselwastewater, <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all h urs of operation: <br /> cac I L"'y .�a ti c - L) <br /> NtiC ;z-E Lr?A- �`i � - 3L`6' Z3 <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. Return original to festival coordinator three weeks prior to <br /> this eve!1k.j <br /> 14. Completed by: Y <br /> Signature Title Date <br /> 5-20 GN <br /> Health Per mlt Hand was"water <br /> Stern.)wlC.hafPng <br /> Dish <br /> Paper Nand Towels <br /> Soap diSpBnSar <br /> Cutting Bnard Sanitize,bucket- <br /> bleach&water for <br /> Prnpune 51ove Bleach <br /> ssonng wiping Cloths <br /> Booth must be on <br /> 114 r <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane rank <br /> Soap and Water E., gr BleacP and VJafcr Garbage <br /> Can <br /> Fire EKt'ngwshe <br /> Ezra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice gags&Food Containers must be Wastewater Container <br /> stoied 6 inches off of fhe ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 6 of 11 TEMP EVENT APP <br /> 060 9119 <br />