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4 <br /> SA , IEnvironmental Health Department <br /> - . ;,' <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 [J Refrigerator <br /> ( Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> 0 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 /> ®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 /> -Frank Teixeira <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�ent <br /> 14. Completed by: c��� ��2G/u� Office Manager 06/21/22 <br /> Signature Title Date <br /> 5-20 Ga <br /> Health Permit Hand wash water <br /> �k S;ama w/Chafrmg <br /> Csn Paper Hand Towes <br /> Soan disaanser <br /> Cutting 5oard $aN[tter 6ucket- <br /> aie'eCh�water for - <br /> Propana S!oie Breach <br /> storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> P-upane Tana <br /> -- scar,and Water R,rise Water 21 ach and Ovate- Garbage <br /> Can <br /> Fire Exte:quish- <br /> Extra <br /> Water <br /> F <br /> F <br /> ice Cooler 5 Gal Ho dwash <br /> Extra Ice Sags R Ftod Containers must he wastewater Conainer <br /> -- - -- s[n a 6 inches c/`oNhe g und, A <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 ( T 209 468-3420 1 F 209 464-0138 i www.sjcehd.com <br /> EHD 16-02 Page 8 of 1 1 TEMP EVENT APP <br /> 07'31t 1 <br />