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imagel.png4/17/26, 12:11 PM , <br />Environmental Health Departme <br />o <br />)R <br />3 <br />••Important” <br />4 Completed by <br />Signature Title <br />[ <br />Ice Cooler <br />SAN JOAQUIN Environmental Health Departm <br />0 ■■ <br />https://mail.google.eom/mail/u/0/#search/gracielacruz81 %40icloud.com/FMfcgzQgKvPxVFGTjvJKLxzqpQbzvhhS?projector=1 1/1 <br />■ ll <br />SGMHMMV <br /> Gartjage <br /> Can <br />Booth Concrete .f <br />Plywood, or <br />All food vendor booths are subject to inspection Please make a copy of this applicatiot <br />preparation for this event A copy of this checklist must be in the booth at all hours <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event <br />GracaolaCruz <br />SAN JOAQUIN <br />------COUNTY <br />I <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods beiov <br />45‘F (if food is used the following day, maintain below 4TF temperature): <br />[~2 Ice chests Refrigerator <br />[ J Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />a-28-26 <br />Date <br />| Health Permit P <br />r <br />4:19 <br />◄ Safari <br />_Z <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Lj Three compartment sink <br />Q 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 />[E Detergent, bleach, and wiping cloths (cleaning towels) <br />3 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 m <br />booth <br />Water supply dispenser with warm waler 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 rmse'wastewater <br />I Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />Gtacwla Glut <br />Carlos cnn <br />s-rooa <br />’nV, <br />868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www sjgov org/ehd <br />HD 1602 PagaSorn TEMP EVENT. <br />701/2024