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R EC-OD8 <br /> S A N 1 O A Q U I N Environmental Health Department <br /> Iu' —COUNTY <br /> Gren-nr•S5 r,rpsv5 ,17rrt <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'F 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 san'ltary 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 100OF (i.e. 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. Names of responsible persons to be present in booth during all hours of operation: <br /> Patricia Vermilus Esaie Vermilus. Rosemarie Sweet <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 testival coordinator three weeks prior to <br /> this event. .�v.b<• -p,rwu ..• <br /> 14. Completed by: b at;ici'zCVA"ta'c I 07-08 Z024 <br /> of iiniiul ....... '° Title Date <br /> 520 Gid <br /> Health Per Ha":,w" I'w:ner <br /> Stereo v.Glllii in <br /> G,r, <br /> Paper Harrel Towels <br /> Soap dispenser <br /> Cul dnp Board Samlrzer bucket, <br /> tNe3ch Swelter for <br /> Propane Slovo 81aaCh storing swpmg cloths <br /> Booth must be on <br /> Concrete,Asphalt. <br /> Plywood,or a Tarp_ <br /> Propane Tank <br /> Soap aoff Water Rinse Water @leach and Water Garbage <br /> Can <br /> Fie ERl urpuisher <br /> Exa a <br /> Wier <br /> FIceooler VI 5Gal liai+d wash <br /> Extra k'e Bags d Food Canraivrs must De Waslev. er Gonlainer <br /> srarcd 6 mcbm oh of fhb ground' <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 f 6-02 Pago 8 of 11 TEMP EVENT APP <br /> 06,'19'19 <br />