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a <br /> S A N 10 A Q U I N Environmental Health Department <br /> .J .1 <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 /> R Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck B 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, one for rinsing and one for a bleach <br /> solution (one tablespoon of bleach per gallon of water). <br /> Tpetergent, 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 /> K Water supply dispenser with warm water at a minimum of 1001F(1.e.5-20 gallon container with spigot). <br /> [-One separate tub(bucket or basin)for the collection of nnselwastewater. <br /> [Paper towels and pump-style sooa container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> ViVI*N THW MkN <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 operation. Return original to festival coordinator three weeks prior to <br /> this event. M,ATIA�j�- <br /> 14. Completed by: <br /> at re Title Date <br /> 5.ermit Hand 20 Gh <br /> Health P ter <br /> Slrma w:ChaEfeg <br /> or,h Paper Nand towa'a <br /> Soen drspensar <br /> Cutrma Beard SO.Wer Nickel, <br /> Neso&water for <br /> slang wiping clothe <br /> Propane Stove &ean <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood.or a Tarp_ <br /> F"Mae.I anll <br /> Soap and Watar Rrnse Water Baas and wrier Garbage <br /> Can <br /> Frre EonnUisher <br /> Etlra <br /> water <br /> Ice Cooler 5Ga,HBM10 wash <br /> I E.lra ke Baas a Fnod Cpnlainers musl be Wessewelar Conlane <br /> nlnred 6 lnrhes ort n!the ground) <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 I www sjcehd.com <br /> EMS 16-02 - Page a of 1.T TEMP EVENT APP <br /> 071307 <br />