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4/24/23, 1:38 PM image1.jpeg <br /> S A N 10A Q U I N r7-111fiir ianmentral Health Department <br /> 0.1-1 r-i _ , <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 /> "'Other(specify) N `—� t.- <br /> 11. I am providing the following items within rn 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: r, ( /A <br /> ❑Water supply dispenser with warm water at a minimum of 1007(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. Na es of�respon�sible. rsons 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 operation. Return original to festival coordinator three weeks prior to <br /> this eve <br /> 14. Completed by: _ ���l,e-E- i_jW 1'i"C�` ���y y <br /> Signature Title Date " <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Sterno w/Chaffing <br /> Dish <br /> Paper Hand Towels 4 <br /> Soap tliepeneor <br /> Cutting Board <br /> Sanitizer buck et- <br /> bleach a water for <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Fire Extinguisher <br /> Can <br /> Extra <br /> Wafer <br /> Ice Cooler i j B Gal Hand wash <br /> t Erma Ice Bags d Food Containers must 6e Wastewater container <br /> -'"�--�_---! stored 6 inches ON of the ground' <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 T 209 468-3420 I IF 209 464-0138 I www,sjgov,org/ehd <br /> EHO 16-02 page 8 of t t <br /> 0611 F/l g TEMP EVENT APP <br /> 1 AAA F <br /> https://mail.google.com/mail/u/O/?tab=rm&ogbl#inbox/QgrcJHsHprbkNHpGbnCfxCKMHnl)lfclVafal?i)roiector=1 1/1 <br />