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r <br /> i <br /> I <br /> -ANit...JOAQUINEnvironmental Healthr Department i <br /> � 1 —CCNUNTY— <br /> � � .. r : <br /> Greatness yrolvs ftere, <br /> 10. I 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 XRefrigerator I <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other (specify) <br /> r <br /> 11 . I 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 /> JO Detergent, bleach , and wiping cloths (cleaning towels) , <br /> ;KTub 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 /> boofh : <br /> t <br /> AWater supply dispenser with warm water at a minimum of 100 ° F (i . e. 5-20 gallon container with spigot) . <br /> f <br /> ❑ One separate tub (bucket or basin) for the collection of rinse/wastewater. { <br /> Paper towels and pump-ale soap container, <br /> I <br /> 13. Names of res onsible persons to be present in booth during all hours of operation : <br /> G rte., M r � i 1�1 e�—y1z £s(2 �-� 73 �7 1 <br /> ' Important" All food vendor booths are subject to inspection . Please make a copy of this application in <br /> 4pr,eparatmon for. this event. A copy of this checklist must be in the booth at all hours of and operati eturn ori inal to festival coordinator three weeks rior to <br /> 14. Completed by: ?lo7 <br /> Sign'N fiure f Title Date <br /> 5-20 Gal, <br /> Health Permit HandwashWater <br /> Sterno wlChafrin@ <br /> Dlsh <br /> Paper Hand Towels <br /> Soap dispenser ; <br /> Culgng Board Sanittzer hucket- I <br /> bleach 6 water for ` <br /> Aropane Stove Bleach storing wiping cloths <br /> Booth - must be on <br /> Concrete, Asphalt, j <br /> a Plywood, ora Tarp . i <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> ':. <br /> Can <br /> Fire Extinguisher - <br /> � ;° Exfra <br /> � Water <br /> , I <br /> Ice Cooler .` t� 5Gal Hand wash <br /> Extra Ice Bags 6 Food Containers must be Wastewater Ccnlalner I <br /> stored B inches off of the ground! <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468-3420 F 209 464-0138 I www.sjcehd . com <br /> EHD 16-02 Page s or 11 TEMP EVENT APP <br /> 0713117 <br />