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• ' li,[�rzf � r <br /> SAN LJ OAQ U I N Environmental Health Department <br /> COUNTY <br /> irt,,,t,;`'-' (irtrlr.nrss gr-t�:vs �rt'Ic•. <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 OF temperature): <br /> .W'Se chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. ; l providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ill'Three compartment sink. <br /> OR <br /> {]"Three deep tubs (basins 6-8 inches rninimum), one for soapy water, one for rinsing and one for a bleach <br /> solution (one tablespoon of bleach per gallon of water). <br /> . Getergent, bleach,and vriping clouts(cleaning towels). <br /> Tub to siore 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 warn water at a minimum of 100aF(i.e. 5-20 gallon container with spigot). <br /> j pC ne separate tub(bucket or basin)for the collection of rinselwastewater. <br /> Paper .towels and pump-style soap container. <br /> 13. Names of responsible persons to be present' 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 a nt. <br /> 14. Completed by: rd'0 <br /> —SignatureU Title Date <br /> 5-20 cal. <br /> Health=Perni1ft <br /> 3land w2sh Waler <br /> StarnouCh;sFisg ! <br /> Dish <br /> Paper Hand Towels <br /> :wapdspen_er t <br /> Cutl'na Hoard SaItizer bucket- <br /> bleach£s;mier for <br /> Propane Store } 01ea�n stcargw8ping dclhs <br /> 1 Bootfi must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane rank <br /> Soap and Water t2nse;Valor Bleach arks'dater Garbage <br /> Can <br /> Fire=xtinp Asher <br /> - t=xtra <br /> Ice Cooler 5 Cal Ha;ta wash <br /> Exue Ica Rags$FacdCo.raters must be Wastewater Container <br /> s1cead6 krchei aff of Me grnurdt <br /> 1868 E. 1-lazelton Avenue ( Stockton, California 952051 T 209 468-34201 F 209 464-0138 ( www.sjgov.org/ehd <br /> EHO iG-02 rpage 8 of i 1 TEMP[VENT APP <br />