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r <br /> SA W J QA Q U I N Environmental Health Department <br /> 10. 1 am providing the hirlowing temperature control for the cold holding of potentially hazardous foods below <br /> 45"F(if food is used the hollowing day. maintAln below 41"F temperature): <br /> Ice chests IJ Refrigerator <br /> (�)Refngerated track '${� Ice bath and tubs <br /> 7 Other(spe6f)')_._ <br /> 11 I am provOino 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 /> so ution (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 /> I 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(Le. 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:c <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. ll on inal to festival coordinator three weeks orior to <br /> is event. <br /> `4. Completed by: � h W , <br /> ignatur Title ! Date <br /> v� 5 20 Gal. <br /> Health Permit HandwashWater <br /> Sterne w/Chaffing <br /> Dish <br /> Paper Hand Toweis <br /> Soap dispenser <br /> ..:,^.end Board <br /> Sanitizer'oucket- <br /> bleach� &watertor Bleach storing wipingcicths <br /> Booth must be on <br /> Concrete,Asphalt. <br /> Plywood,or a Tarp <br /> `p. Soap and Walor Rinse Water Bleach and Water <br /> Garbage <br /> Fire Ext ngulsher Can <br /> Extra <br /> Water <br /> 77 <br /> Ice Cooler <br /> 5 Gal Band wash <br /> ExbU!cv Bays&Food Conluigers nwst Ga Wastewater Container <br /> storod�rnchos of7o/fhu Around! <br /> 1868 E. Hazeiton Avenue, I Stockton, California 95205 T <br /> 6/2 1&02 I 09 468-3420 F 209 464-0133EHD j www.sjgOV.orgtehd <br /> OG/2tl/2023 f't�go ti of 1 <br /> TEMP EVENT APP <br />