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� t <br /> SA N J DA IS I N Environmental Health Department <br /> C O U Ire T Y <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 /> ❑ ce chests ❑ Refrigerator <br /> Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. J 4rn 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 followinq for adequate hand washing facilities but separate fr utensil wash within my <br /> booth: � wa�rm!KXniutm <br /> � . e. 5-20 allon container with spigot). <br /> ❑Water Nsup ly d spenserwith g <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 o ion. Return on inal to festival coordinator three weeks prior to <br /> this event. _JU VVYU t ��L <br /> �/Y14. Completed by: 1M <br /> i ure 22- <br /> Title ate <br /> 5-20 Gal. <br /> Health Per Hand wash Water <br /> Sterno w/Chaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> ------------- <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extlnqulsher <br /> Extra <br /> Water <br /> Ice Cooler I -' 5 Gal Hand wash <br /> Extra Ice Bags&Food containers must be Wastewater Container <br /> -- ------------------ stored 6 inches off of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page B of 11 TEMP EVENT APP <br /> 0713/17 <br />