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�.- SAN JOAQUIN a <br /> Environmental Health Department <br /> 49 - COUNTY <br /> C' n �. Greatness 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 100°F (i.e. 5-20 gallon container with spigot). <br /> ® One separate tub (bucket or basin)for the collection of rinselwastewater. <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 /> David Herrera . Jose Carlos Flores . <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: Nov/17/2 21 <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit terno wlCha Iiandwash Water <br /> — <br /> Dish <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitize' <br /> h.cket- <br /> bleach 8 Water for <br /> Propane Stovq Bleach stonng wiping cloths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Prmarp lank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> LC <br /> COo�er SC,aS Hand wash <br /> Extra fee Bags 8 Food Conrairlors mu5r be Wastewater Container <br /> stored 6 inches off of the ground! 1111 <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 /> 061191f 9 <br />