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DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />R EC-008 <br /> <br />SAN)JOAQUIN <br /> <br />Environmental Health Department <br />..: , —COUNTY— <br />IFO'e Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> <br />45°F (if food is used the followin maintain below 41°F temperature): <br />4 <br />Ice chests <br />ther (specify) <br />Refrigerator <br />efrigerated truck Ice bath and tubs <br />1-21:ri providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Ihree 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 />Il <br />ion (one tablespoon of bleach per gallon of water). <br />etergent, bleach, and wiping cloths (cleaning towels). <br />lub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />FINater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Alejandro Kandalaft, Maria Castillo, Armando Carbajal <br />Cutting Board <br />Propane Stove <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 />SUBMIT <br />Signature <br />5-20 Gal. <br />Hand wash Water <br />Paper Hand Towels <br />Sanitizer bucket- <br />bleach &water for <br />storing Wping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />"Important** <br />14. Completed by: <br />Health Permit <br />Owner <br />Title Date <br />Sterne w/Chatting <br />Dish <br /> <br />Soap dispenser <br />Garbage <br />Can <br />l <br />ice Cooler <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 15-02 Page 8 of 11 TEMP EVENT APP <br />0611919