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SA N J OAQ U I N Environmental Health Department <br /> --COUNTY- <br /> 7 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 /> 2 1ce 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 /> Z 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 100aF (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 /> 1 e Z1741)4. d"el <br /> �-�[i�P•7 Tic .�9fa rZ;1��c,vi.�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 event. <br /> 14. Completed by: [ K r�i rr��1�' J z -%-i 7 <br /> Signature Title Date <br /> &20 Gal. <br /> Health Permit Hand wash Water <br /> Stemo w/Chafgng <br /> Dish Scrap dispenser Paper Hand Towels <br /> Cutting Board San;17er buokQIhrr <br /> blea�8 water Bleach <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank - <br /> Scrap and Water Hinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> stored 6 inches offolrhe ground) <br /> 1868 E- Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 } www.sicehd.com <br /> EHD 1M2 Page 8 of 11 TEMP EVENT APP <br /> Q713117 <br />