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N J U A Q U 1 r Envi on€"n nt 0 Health Department <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 da , maintain below 41 OF temperature): <br /> lice chests Xfrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> hree 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 /> etergent,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. Name)06 <br /> responsible persons to be present in booth during all hours of operation: <br /> 1*�re't5 f) V 1 <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 roust be in the booth at all hours of <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this even-t.. F j <br /> 14. Completed by: cwo 0-C 12 G-t <br /> Signature Title Da <br /> 5-20 Gat. <br /> Health Permit Rand wash Water <br /> Sterno wlChaffing <br /> t;ish <br /> Paper Hand Towets <br /> Soap disaenser <br /> Cutt:nq Board SaniNxer bucket- <br /> bleach&water for <br /> Proaane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> P - Concrete,Asphalt, <br /> ❑:.:; <br /> Plywood,or a Tarp. <br /> Propane lank <br /> Soap ancf V�ater Rinse 41'ater Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> 1Yaier <br /> Ice Cooler � � ''_ : u v 3,'y 5 Gat Hand wash <br /> Extra!ce Bags&Food Containers roust be Wastewater Container <br /> stood 6 inches oft of the ground <br /> EF, I <br /> 868 E. Hazelton Avenue l Stockton, California 95205 l T 209 468-3420 l F 209 464-0138 l vrsraw.sjgov.org/ehd <br /> EHD 16-02 Page a of 11 TEMP EVENT APP <br /> nFti�i114 <br />