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--2, SQ N J QAQ U S N Environmental Health Department <br /> r, <br /> COUNTY <br /> Grzomess grows here. <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 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 1007(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 puma-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> RosaElena Menendez&Fabiola Gutierrez <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. or EjUGq-T1C)1V / <br /> 14. Completed by: /�Sl�T1FlUT �'�" a(0 f� <br /> Si ature Title Da e <br /> 5-2n Gal. <br /> Health Per Hard wash Water <br /> Stemo wlChatfing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board <br /> 5anitlzer bucket- <br /> 1\ <br /> bleach&water for <br /> Propane Stove Hleeoh <br /> storing wiping d"ths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propano Tank <br /> �:. <br /> Soap and water Rlnse Water Bleach and Wafer Garbage <br /> -Ire Eatingulsher Can <br /> Exrra <br /> water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Hags&Food Contalners must be Wastewater Conl ner <br /> stored 6lnches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 , www.sjcehd.corn <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713/17 <br />