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J <br /> SANd0A0u1N Environmental Health Department <br /> '•'' ---COUNTY <br /> G,ratness grows here. <br /> 10. 1 am providing the following mid temperature control for the cold holding of potentially hazardous foods below <br /> 451Ir(if food is used the following day,maintain below 41'F temperature): <br /> M Ice chests X Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> _ ❑Other(specify <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> 8Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> ution(one tablespoon of bleach per gallon of water). <br /> ❑Detergent bleach,and wiping cloths(cleaning towels). � s <br /> ❑Tub to store wiping cloths in bleach solution. - <br /> 12. 1 am providing the following for adequate hand washing facilides, but separate from utensil wash within my <br /> booth: <br /> Water supply dispenser with warn water at a minimum of 100'F(l.e.5.20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of iinsetwastewater. ! <br /> xPaper towels and um agalp container. ,,• ; <br /> 13. Na�es�j('egf, �JKbi s to be present in booth during all hours of operation: <br /> H <br /> C w , <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 operati etur Inaf to festival i for three weeks prior to <br /> this avant. <br /> 14. Completed by: <br /> Signature Title Date <br /> tl sac OIL <br /> Health Pemtit "s"d"a"'VIOW <br /> uen <br /> Paper FWfd Tarrd! <br /> Soap dhpeMei T - _ - <br /> OBrbd _ SWffierbaticth- <br /> . . b%W&"Ur for <br /> P.'.~S. <br /> _ �.- B1e.cb - tIaYD+rTMrg dofi <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,ar a Tarp <br /> PMPW-Tw* Ur <br /> Sapandwebr raec.w.ar Mach AM WON � <br /> t File EmrgiWw F Can <br /> Ice Cooler 5 C4 HWW wash :+ <br /> fie to BKa d Foad CwftL+*mwl bw waswomw cbnukwr <br /> aP,red O Yithes add dw�anrtlP <br /> 1868 E.Hazelton Avenue I Stockton,Calrfomla 95205 i T 209 468-3420 F 209 464-0138 1 www.sjgov.orWehd <br /> EHD 16432 Page a of 11 7EMP EVENT APP <br /> O6f18l19 <br />