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SAN JOAQUIN Environmental Health Department <br /> C 0 U NTY <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457(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 sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> ® Three deep tubs (basins 6-6 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 100'F (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 /> Ka heleen Camarmflo <br /> Samantha Ouk <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 roust be in the booth at all hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. kW <br /> 14. Completed by: CEO 7111124 <br /> Signature Title Date <br /> 5-20 Gal <br /> Health Permit Ste Hand wash Water <br /> mo rChaf wTing <br /> DiSh <br /> Paper Hand Towels <br /> Snap disoenser <br /> Cuninq Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Store Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propene Tank <br /> ,> Soap and Water Rinse Water Bleach and Water Garbage <br /> �i Can <br /> Fire Exhnguisher <br /> Extra <br /> water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Saga,Food Confainars must be wastawater Container <br /> stored 6 inches off of the groundl <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 C F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 07a17 <br />