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SA N 10AQ U I N Environmental Health Department <br /> - 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) 0 St p <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 responsibl persons to be present in booth during all hours of operation: <br /> J �,`^'�`� r r Q r c� <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 , c <br /> 14. Completed by: ` P 3 //— <br /> S' na re Title Date <br /> `- 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Sterno w/Chaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Stove <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood, or a Tarp. <br /> Propane Tank <br /> -N•`. Soap and Water Rinse Waler Bleach and Water Garbage <br /> 9 <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> f i Extra Ice Bags&Food Containers must be Wastewater Container <br /> -- - stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 07/3117 <br />