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SA N J OAQ 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"F temperature): <br /> ❑ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> (l Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning,of food preparation utensil <br /> y ❑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). c <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 100eF(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 /> **Irnportant** 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 oper ton. Return original to festival coordinator,three weeks prior to <br /> this event. __ <br /> 14. Completed by: d <br /> �-N-Sleria <br /> 1 Title /Dataf <br /> -20 Gal. <br /> Health Permit Sta Hand wash Plpler <br /> n wlChalfmg <br /> Diah <br /> Paper Hand Towels <br /> $onlr dispenser <br /> Culting Aoatd 9anihze,bucket <br /> hluach fA 1,01ef ter <br /> Propnnc stove Bloach stamp Wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp, <br /> Pre:lane Tnnk - <br /> Soap and Wntar Rhea Water Hlench and Water Garbage <br /> Can <br /> - Pre Conguishne <br /> Celrn <br /> Wales <br /> t <br /> Ice Cooler I »:: " •``''' kF.' 4Fw :- ^::^3 5Gal hWnd wash <br /> J;r Esnn Ice 60,95 d POW Callarnam nlusf ba ,Y Waetawater Contniner <br /> 3 !7!a Inches off Who pmunrN <br /> 1868 E. Hazeiton Avenue, Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 1&02 Page 8 of 11 TEMP EVENT APP <br /> 00119119 <br />