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r <br /> S A N 10 A Q U I N Environmental Health Department <br /> -COUNTY <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 eF temperature): <br /> �] Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am 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 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 rinsetwastewater, <br /> 7 Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> , a hin °�ro <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 oriqinal to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by: �lM►1P,.4x 7 Z4 o ?�1,2- <br /> ignature Title bate <br /> 5-2o Gal <br /> Health Permit Hand wash Water <br /> Sterna w/Chaffing <br /> Drsh Paper Hand Towe s <br /> Soap dspenser <br /> Cutunq Board saruuzer bucket- <br /> bleach d water for <br /> Propane stovo <br /> Bleach staring wiping o ams; <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tani( <br /> Soap and VJalnr R,nse Water Bleach and Water <br /> Garbage <br /> Can <br /> F,re EYt�nqulaher <br /> EYI'a <br /> LVa'er <br /> fIcTeoole7r ,' 5 Gal Hand wash <br /> Er"Ice Bags d Food Cantawers must be Wastewater Contanar <br /> stared 6 mcnes op of the graundu <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 mvw.sjcehd.com <br /> EHD 16-02 Page 8 cf 11 TEMP EVENT APP <br /> 0713117 <br />