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&woo vi Chillfwg <br />Dish <br />b-20 Oat, <br />Hand wash Wale( <br />Pnper Hand TOM•ehi <br />Sanditof bigkol• <br />hloacliI water lur <br />clubbij tglibt) cluffis <br />Booth must be on <br />Concreto, Asphalt, <br />Plywood, or a Tarp, <br />Novanetliuro <br />rimse riAlot O.d, III 111 Wdlel Garbage <br />Can <br />I-fro L4114051101 <br />Eitra <br />fc-e-Cooler ; <br />i <br />Ell! .1 Ice Rigs d Food Co/nacos buist be <br />414,1 d 6 !mix% etf oJ Ibe groubd, <br />N nal <br />WatevAller Coolant' <br />Soap dispohs,er <br />Health Permit <br />"'N <br />DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />REC-008 <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />C U Y <br />10, I am providing the following cold temperature control for the cold holding at potentially hazardous foods below <br />45°F (if food is used the following day; maintain below 41°F temperature): <br />03 Ice chests <br /> Refrigerator <br />0 Refrigerated truck El Ice bath and tubs <br />0 Other (specify) <br />preparation utensil <br />rinsing and one for a bleach <br />11. I am providing the following items within my booth for the sanitary cleaning of food <br />OR <br /> D Three compartment sink. <br />0 Three deep tubs (basins 6-8 inches minimum), one for soapy water, ,one for <br />solution (one tablespoon of bleach per gallon of water). <br />CI Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution. <br />12. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Cs] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />LN, One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />IR Paper towels and pump-style soap container. <br />N es of responsible persons to be present in booth during all hours of operation: <br />Completed by: 4/Cdikfrp., <br />Signature <br />1858 E. Haelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 (164-0138 1 www.sigov.org/eld <br />EI-10 16 02 Pogo 8 of It TEMP EVENT APP <br />claims <br />:•1/4-1,-t <br />Important** <br />1'101'1-Van <br />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 event. <br />Qwne_e- C21 '26 / '2Ct <br />Date Title