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"% :N-- Environmental Health Department <br /> artment4 . lr <br /> COUNTY <br /> Crea ness. grows here: <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF (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 /> 0 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 /> gDetergent, bleach, and wiping cloths(cleaning towels). <br /> ub 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 /> 1160ne separate tub (bucket or basin)for the collection of rinselwastewater, <br /> [:Paper towels and pumR-style soap container. <br /> 13. Name2s f re�onsib e er n$o s to be present in booth during all hours of operation: <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 ev #. <br /> 14. Completed by: _�/�,�_ � -tq <br /> S' ture Title Date <br /> &20 Gal. <br /> 1 <br /> Health Permit HandwashWater <br /> Sterna wlChaffng <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanilizer huckat- <br /> bteach 8 water for <br /> Propane Stove Bleach <br /> storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane <br /> f <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> r--.: Can <br /> Fire Extinguisher <br /> - Exva <br /> Water <br /> �Ce CQO� SGal Hand wash <br /> Jr ,_ Fxtra Ice Sags d,Food Containers must be Wastewater Container <br /> stored 8 inches off o1 the groundl <br /> 1868 E. Haze€tan Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjoehd.com <br /> EHO 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713117 <br />