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S A N 10 A Q U I N Environmental Health Department <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the following day, maintain below 41°F temperature): <br /> ❑ Ice chests Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> E) Other(specify) _ <br /> 11. `11aam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> OR ' `Three compartment sink. <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 /> 11�4 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 rinselwastewater. <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible perso to be present in booth during all hours of operation: <br /> "Important All food vendor bootks-aP6 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 orior to <br /> 14. Completed by: Al� <br /> ignature F Title Date <br /> 5-20 Gal <br /> Health Permit Hand wash water <br /> Stern wrCnafSng <br /> Drsh <br /> Paper Hand Towels <br /> Soap nisp(vtser <br /> Cutling Boartl Sar"luer t"k01- <br /> bleach a orator for <br /> Propane Slove &earn <br /> staring-toping dotns <br /> Booth must be an <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp <br /> Propane Tank <br /> Soap and water I Rinse wafer REea;h a.1d wale, Garbage <br /> Can <br /> Fire EaUna_wshe• <br /> F1,sra <br /> /'� <br /> Wal2r <br /> FIce Cooler SGal Henn organ <br /> Ema I�flags 6 F000 Cnnfaenars Huai be wastewater Con amer <br /> aKxed 5inches of of the ground' F I <br /> 1868 E Hazelton Avenue ! Stockton, California 95205 ! T 209 468-3420 ! F 209•164-0138 I Nww.sjcehd com <br /> EHD 16-02 Page B of 11 TEMP EVENT APP <br /> D71al17 <br />