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5 A N ..J OA Q U I N Environmental Health Department <br /> COUNTv- <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 417 temperature).- <br /> El Ice chests ❑ Refrigerator A//� <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, x / <br /> OR f//A <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 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 /> 0 ci f r �7 i-ro s <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 peration. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: LC�'LL G��l�(i"f'e02_ / <br /> Signature Title Date <br /> Ozer; r: <br /> � 5-20 Gat. <br /> Health Permit Hand wash Water <br /> Sremo wfChaffing <br /> Dish <br /> Piper Hand TOwe[s <br /> 5oan tliSpenser <br /> Cur[!n3 Board Sanitizes bucket. <br /> bleach&water for <br /> Propane Stave Bleach storing wiping cloths <br /> _ [[wvrF.rnuc[be on <br /> Concrete,Asphalt, <br /> k Plywood,or a Tarp. <br /> Propane Tank <br /> 5aap and plater Rinse Water bleach and YVaTr <br /> Garbage <br /> Can <br /> Fire Exurgjd;er <br /> Exva <br /> ff^-' w32M <br /> Ice Cooler r 5 Gar Harts wash <br /> Extra ire Sags&Food Containers must be Wastewater Container <br /> --- siered 6 inches off of the ground! <br /> 1865 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06M M 9 <br />