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REC-COO <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12 <br />13. <br />••Important** <br />weeks prior to <br />08/22/2024 SUBMITCompleted by: 14. <br />Signature Date <br />Hoaith Permit <br />Ptapant <br />I <br />>-XtU'W <br />G <br />Ikwu-ar?®r <br />L <br />All food vendor booths are subject to inspection. Please make a copy ot this application m <br />preparation lor this event. A copy ol this chccKHst must be m the booth at all hours oi <br />preparation and operation. Return original to festival coordinator three <br />this event. <br />✓ Refrigerator <br />ico bath and tubs <br />S Ua ”«nd wi*/* <br />tviil.m- Cort««o <br />Names ol rosponstolc persons to bo present n booth during all hours ot operation: <br />Alejandro Kandalaft, Maria Castillo. Armando Carbajal <br />8*rno»Cra*Mp <br />Q«h <br />Can <br />Bocth muU W or <br />Ccrcrefe. AsnhaA <br />Plywood, or a Tarp <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockion. Cal lorma 95205 T 209 468-3420 1 F 209 464-0138 I www5jgov.org/chd <br />DOie-oe p»jcisrfu tup evt was’ia.w <br />Lao? providing the iollowing items within my booth lor the sanitary cleaning ol food preparation utensil <br />✓jhrec compartment sink. <br />deep tubs (basns 6-8 inches minimum), one lor soapy water, one lor rinsing and one lor a Wcach <br />—*ition (one tablespoon ol bleach per gallon ol water). <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />ub to store wiping cloths in bleach solution. <br />I am providing the following tor adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[✓JiVatcr supply dispenser with warm water at a minimum of 100dF (i c 5-20 gallon container with spigot). <br />[✓foe separate tub {bucket or basin) lor the collection ol nnscAvastcwatcr. <br />[✓^apcr towets and pump-style soap container. <br />/ I Oc» re fi&zt < ram evil «* ■ <br />SAN JOAQUIN <br />------COUNTY------- <br />GrcotntM qro-s here <br />I am°providng the following cold temperature control lor the cold holding oi potentially hazardous foods below <br />—^5°F (il food is used the fofiowma day, maintain below 4ieF temperature): <br />'co chests <br />__Reingcratcd truck <br />Other (specify) <br />I Svoj »««>■*« I — <br />O^ner______ <br />Title <br />r_Z__ <br />M>«m | | tSaatft ano ***«•