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i <br /> I <br /> i <br /> toe <br /> Environmental Health Department <br /> -COUNTYS : <br /> I <br /> w �• t <br /> Greatness grows hers:. <br /> 14. ! am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF (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) <br /> 11 . I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> $4-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) , I <br /> ❑ Detergent, bleach , and wiping cloths (cleaning towels) . <br /> ❑ Tub to store wiping cloths in bleach solution . <br /> 12. I 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 (Le, 5 -20 gallon container with spigot) . <br /> r <br /> ❑ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> 9 Paper towels and • pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation : <br /> *A�Oqj Y0 <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 orlor to <br /> this t. <br /> 14 . Completed by: �� y� �` <br /> l <br /> 81g1hature Title Date <br /> 5-20 Gel. <br /> Health Permit Hand wash Water <br /> Stomo w/chaffing <br /> Ash i <br /> PaperHand Towels <br /> Soap dlapenser ,' <br /> Cutting Boa rl <br /> Sanitizerbucket I <br /> bleach & water for i <br /> Prapano Stove Bleach storing wiping cloths <br /> E30 th. rnust be on <br /> s Concrete , Asphalt, <br /> s 1 Plywood, or a Tarp. <br /> Propane Tank <br /> I <br /> Soap and Water Rlnso Water Bleach and Water Garbage ' <br /> 1 "s fire Extinguisher <br /> Can <br /> _ Water ' <br /> (ce Cooler <br /> fi Gal Hand wash - <br /> Extra fce fts & Food Containers must be We to <br /> waterCanlalnor <br /> stored6inches off ofthegroundl <br /> 1866 E. Hazelton Avenue Stockton , California 95205 T 209 468-3420 1 F 209 464-0138 www. sjcehd .com <br /> EHD 16. 02 Page B of 11 <br /> 07!3117 TEMP EVENT APP <br /> i <br />