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S A N J Q 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 aF temperature): <br /> Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ 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 /> OR <br /> ElThree compartment sink. /t / <br /> / V <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: n;r i <br /> A- <br /> El 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 rinse/wastewater, <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <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 ev _ <br /> 14. Completed by: � <br /> n tore Title Date <br /> 5.20 Gal. <br /> Health Permit Hand wash Water <br /> Sterna wlChafring <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cuffing Board Sanitizer bucket- <br /> bleach 4 water for <br /> Propane Stove Bleach storing wiping troths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water RinseWater Bleach and water Garbage <br /> Can <br /> Flre Extinguisher <br /> Extra <br /> Water <br /> (Ice Cooler — :--- _ ,_ -� .-- "- `- � �-�-� -�� - 1 5 Gal Hand wash <br /> { I(�E'rra!ce 8ags P Food Conlainors must be wastewater Container <br /> -'- -- ( stored 6 inches off of/he grounds <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 F 209 464-0138 ; www.sjcehd.com <br /> EHD 16-02 Page 6 of 1 i TEMP EVENT APP <br /> 0713117 <br />