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1 <br /> S A N 10 A Q U I N Environmental Health Department <br /> -- COUNTY <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45eF(if food is used the following da ,maintain below 41 aF temperature): <br /> [I 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 /> ❑Three compartment sink. <br /> OR <br /> M/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 100eF(i.o.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. {dames of fe,Is l le persons to be present in booth during all hours of operation: <br /> f� kf,-r <br /> "Important' All food vendor booths are subject to inspection. Please make a copy of this application In <br /> preparation or this event. A copy of this checklist must be in the booth at all hours of <br /> preparation n operation. Return on inal to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: 2 i!v trr �Iff1lr'r2 Foy .�1U o?U L <br /> gnature Title Date <br /> 6-20 G.J. <br /> Health Permit Hand wash Water <br /> 5tvrno wlChalfing <br /> nlah I , <br /> Paper Hantl Towala <br /> Soap dapereer <br /> Cuttirg board Svvftlxar hucket- <br /> bleech&wale!or <br /> Pwpana Slave Bleach stollnp wipinu dolbe <br /> Booth rr1USt be 4n <br /> Concrete,Asphalt, <br /> Ad :r r- veiy" Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and water nut.e wafer olaacn a,w wntar Garbage <br /> Can <br /> Fire Extrpuiehet <br /> Ealra <br /> Wafer <br /> Ice Cooler I MM S Gal Havd wash <br /> Eairo!ca Baga d Food Crnlainera mw76v Waalewnle+Con,- <br /> sromd6lhcheaafrorlhapround? <br /> 1868 E. Hazelton Avenue I Stockton. California 95205 T 209 468-3420 F 209 464-0138 www.sjgov.org/ehd <br /> EH❑16{52 Pope 8 of 11 TEMP EVENT APP <br /> 0812 912 0 2 3 <br />