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r ' <br /> SA ]OAQUIN Environmental Health Department <br /> ........`,'DU N T V <br /> 10. 1 am providing the fallowing 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 <br /> ❑ Refrigerated truck ❑ ice bath and tubs <br /> Q Other(specify} 0 o►en m �>-r a rd <br /> 11. 1 am providing the following items within my tooth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> 0 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 /> ® 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 /> [Z 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 /> thP,mvent. <br /> 14. Completed by: M > "-4 . -C'— <br /> signature Title Date <br /> 5-20 Gal. <br /> =Heaithermit Ste Hand wash Water <br /> mq wiCha(5ng <br /> Dish Paper Hand Towels <br /> Soap dispenser <br /> Cuttlnp Board Sanitizes buckel- <br /> bleach&water for <br /> Propane Siove <br /> Bleach staring wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> 7. <br /> Propane Tang <br /> Soap and Water Rinse Weter Bleach and Water Garbage <br /> Can <br /> Rre Exlinquiahar <br /> E><t+a <br /> Water <br /> )Ce CooIer`Vj, .; 5 Go)Hand wash <br /> Extra Ice Bags&Food Coolainers must be Wastewater Container <br /> _.__._...,___.___...._......:....!f' stared 6 inches aft of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 46$-3420 F 209 464-fl138 1 www,sjcehd.cam <br /> EHO 16-02 Page 8 of 11 TEMP EVENT APP <br /> 0713f17 <br />