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SA N of OAQ U 1 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 /> ® Other(specify) ELECTRIC ICE CHEST <br /> 11. 1 am providing 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 /> 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: <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 rinsetwastewater. <br /> ® Paper towels and hump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> ARMANDO ISAIS, TERRI ISAIS <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 event. <br /> 14. Completed by: xqt�2t 444.e..�_ OWNER 4/27/2026 <br /> Signature Title Date <br /> 5.2o Gal. <br /> Health Permit Hand washWalar <br /> Stems wlChaffmg <br /> D,sh <br /> Paper Hand Towels <br /> Soap dispenser <br /> Culling Board Sanlgzer bucket- <br /> bleach 8 water for <br /> Propane Stove <br /> Bleach staring wiping cloths <br /> Booth must be on <br /> U Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank - - - <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> .. Fire Extinguisher <br /> Extra <br /> Water <br /> fice—co-oler 5GalHandwashFxfra ice Bags&Food Containers must beer- stored 6 inches off oflhe ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHd 16-02 Page 8 of 11 TEMP EVENT APR <br /> 06/19119 <br />