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Health Permit <br />= lab 1.1 <br />I <br />Propane Ionic ., <br />1 <br />4 <br />&lap Atli Walor <br />Flro Exa no lab Br <br />rloe Cooler <br />&Pa Ica Does 3 Food Conleleors most ha <br />slated a inches off Of Ihe °mond/ <br />Nato Walor Gothno <br />Con <br />soap daponsor <br />on! Hose math <br />West auto? CminIner <br />onfaxa rbuckol- <br />blooch A win atior <br />s!orIng vripIng cblhs <br />Booth must be on <br />Ooncrew, Asphall, <br />Plywood, ore Tarp. <br />DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />REG-008 <br />SA\sJOAQUIN <br />—C <br />G r et,t t nes 5 9 r o ves here, <br />Environmental Health Department <br />10, I am providing the following cold temperature control for to cold holding of potentially hazardous foods below <br />11_!; <br />1 5°F (If food Is used the followin , maintain below 41°F temperature): <br /> Ice chests Refrigerator <br />elrigerated truck ice bath and tubs <br />ther (specify) <br />11.ri providing the following Items within my booth lor the sanitary cleaning of food preparation utensil <br />lihree compartment sink, I 'Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for a bleach <br />[—Ilion (one tablespoon of bleach per gallon of water). <br />I 'Detergent, bleach, and wiping cloths (cleaning towels). <br />rub 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 />Tjvaier supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />FThne separate tub (bucket or basin) lor the collection of rinse/wastewater. <br />nem towels and pump-style soap container, <br />Names of responsible persons 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 orloinal to festival coordinator three weeks prior 10 <br />this event. <br />Completed by: Rawad Annan <br /> Manager 04/17/2024 <br />2ciriiiiu re Title Dale <br />OR <br />CultJap Baud <br />Propane aawo <br />Slatm walhaltins <br />G1sh <br />6-4 Gal. <br />Hand wash %Valor <br />Popo( Hans( Towels <br />1868 E. Hazelton Avenue I Stockton, California 052051 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />Eifo16,02 PagoSof It TEMP EVENT APP <br />06/19/is