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SA N J Q A U 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 /> 45°F(if food is used the following day, maintain below 41°F temperature): <br /> ❑ Ice chests ❑ Refrigerator <br /> 171 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 6-8 inches minimum), one for soapy water, ene 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 rinsetwastewater. <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 a d operation. Return original to festival coordinator three weeks prior to <br /> th event. 04/16/2025 <br /> 14. Completed by: Owner <br /> "'Paturev Title Date <br /> Health Per Han°`'rush water <br /> Elmo wlChaRrq <br /> Pop-Hsnd T—Is <br /> Soap tllsponser <br /> Coiling Boar6 Sandier bucket- <br /> bleach 6 wa:ar for <br /> Prcyare Slo:a FJea� siohnq wiaing Dohs <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Prx:a.�c Fork e`[ <br /> Scrap and Walor Rinse Water akorh and Wa'er I <br /> Garbage <br /> Can <br /> Fire Eainguisher <br /> E%r! <br /> v�'a:er <br /> rITeCooler I I._. _.... -----_ -I SGal liana.vaz•� <br /> Echo lce Bags 6 Food Con7s%n:rs mus7 be J WaStevrdlef Cc�:ater <br /> - slorcd 6 MChCS 0l/0l17rB groundf <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 f F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 8 or 11 TEMP EVEHTAPP <br /> 0713117 <br />