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SAN J OAQ U I N Environmental Health Department <br /> Y, <br /> "JhKZIr ' COUNTY <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 /> ❑ 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 /> CAR nc GAI I ARDO ADRIANA [BARRA CHRISTOPHER MOCTF7UMA MARCFI n r;Al LARDO.ARELY GALLARDQ. <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 event. <br /> 14. Completed by owner 09M 2-' <br /> Signature Title Date <br /> 5-20 Gal <br /> Health Permit — - HanC wash Waller <br /> 1 Paper Hand Towets <br /> Soap dispenser <br /> SanchdeaU 6 oAMersier for <br /> stonng wppng do1M <br /> Bleach <br /> I <br /> Booth must be on <br /> Concrete.Asphalt. <br /> Plywood,or a Tarp. <br /> LF <br /> Soap and Wale,, Pr";r:7r der Bleach d: _ I Garbage <br /> Can <br /> Fre Ednguisher <br /> Eilra <br /> Water <br /> Ice Cooler 5Gal Hand wash <br /> 1Eift ke Sa <br /> g x�C:r S te WasilewaterContainer <br /> y farad 6 kcAes o.T of V±e grounC' <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 8 of 11 TEMP EVENT APP <br /> O6/29/2023 <br />