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SANEJUAQUIN Environmental Health Department <br /> COUNTY <br /> zc,rna�" Greatness grows here. <br /> 10. I 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 /> 2�lce chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) m,Q?mot �` <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 /> EY 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 /> L!Water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> 15`6ne separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Names 9f responsible persons to be present in booth during all hours of operation: <br /> G,-,-,Z n <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 /> ,- � <br /> r7 <br /> 14. Completed by: this event. 7-' <br /> aidifature Tltle Date <br /> 5-20 Gal. <br /> Health Permit Handwsshwa;or <br /> Stoma w{cha.1fin0 <br /> Dish <br /> Paper Hand 7o++s<ts <br /> Scopdapa^sor <br /> Cu:linp eoarJ S:,r'bzer bc;cke!- <br /> Clcadl6 wa;orfor <br /> Proo:+no S;cw elea�l <br /> a:crpg µ{,ping dohs <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,cra Tarp. <br /> PropanoTark - •/ <br /> Soap and�Va'or Finse WaIC• &Ita anc!�'la;C Garbage <br /> Can <br /> Fxo E.4ndwsher <br /> f�nra <br /> 17o'.,r <br /> Ice Cooler 5 Gal Handwash <br /> Extm Ice Bags 3 Food CAr!CJ76.'s must be 1Yas;c,n!cr CcN rarer <br /> varod O Inches cOof uro 5rtxex:! <br /> 1868 E.Hazelton Avenue 1 Stockton, California 95205 j T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 16-02 Pape 8 or 11 TUIP EVENT APP <br /> CM912023 <br />