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S A �QQ Q E N Environmental Health Department <br /> COUNTY <br /> ' Gr,ryctn,ss oroivs hcrr. <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 &irRefrigerator <br /> ❑ Refrigerated truck Vice 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 /> J'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 /> WTub 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 /> JZWater 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. fumes of responsible persons to be present in booth during all hours of operation: <br /> Jonathan and Kim Pasamonte (Partners) <br /> "*Important" All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation Ltthhis event. A copy of this checklist must be in the booth at all hours of <br /> preparationra on. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: Owner �4/1/2025 <br /> n ture Title Date <br /> 6-20 Gal <br /> Health Permit Hand wash Water <br /> Slemo wlChatang <br /> Dish <br /> Paper Hand Towels <br /> SoaA dispenser <br /> Golfing Board sanitlzer bucket- <br /> bleach&waterfor <br /> Propane Stove <br /> Bleach Melling wiping Goths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> - - - Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and VL'ater Rinse Water Bleach and water Garbage <br /> Can <br /> Fire Extingulshar <br /> Extra <br /> water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags 8 Food Confainefs must be wastewater Container <br /> stored 6 inches off of the ground? <br /> 1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 j www.sjgov.org/ehd <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 06129/2023 <br />