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r urar <br /> "tA <br /> SAN.dOAQUINEnvironmental Health Department <br /> CaUNTY <br /> +•'lr./)ri>t'•���• Grertt;lws!, grows hfrre. <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 ❑Refrigerator AIA <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> Other(specify) 1Jd-,Cwvk64" i5 An�h, L iN (�9 Ade I�LIX � " tic <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 /> 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 /> E, <br /> (x Water supply dispenser with warm water-at a minimum of 100OF(i.e. 5-20 gallon container with spigot). <br /> ( 'One separate tub(bucket or basin)for the collection of rinsefwastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Names of respopsible persons to be present in booth during all hours of operation: <br /> /-n <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 ration. Return original to festival coordinator three weeks prior to <br /> this even. <br /> 14. Completed by: AdUt✓/`—s-i t %Z 1 <br /> Sig ature TltlU V 16ate <br /> S-20 cal. <br /> Health Permit Hand wash Water <br /> Stereo wJChatgng <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanluzer buckot- <br /> bleach&water for <br /> PrepeneSlove Bleach . Storing Wping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse wetar Bleach and Water Garbage <br /> Can <br /> Fire Extinpulsher <br /> OOF <br /> Ice Cooler ® S Gal Hand wash <br /> Extre 1co Bags&Food Confalnam must be Wastewater Container <br /> stored 6Inches off of fie groungt <br /> 1868 E. Hazelton Avenue( Stockton, California 952051 T 209 468-3420 I F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16•02 Page 8 of 11 TEMP EVENT APP <br /> 08/19/19 <br />