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Environmental Health Department <br />w. <br />11. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />"Important** <br />14.Completed by: <br />Health Permit <br />Pape' HarKj fosreli <br />Prap*'* Stove <br />I <br />Pi!«•’<< Tai* <br />Uleecli .iixl wat« <br />frV EXWlOHV'*' <br />Ice Cooler <br />Refrigerator <br />Ice bath and tubs <br />S Gs HanU wwMi <br />WMIevmlei OliWwi <br />Garbage <br />Can <br />Sarvluer txiOet- <br />cleadi 4 'miner fo» <br />1 luting ftiping clollls <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />St emo a.CluPny <br />Dlttt <br />5-20 G*l <br />•Urxl naeli Weter <br />Names of responsible persons to be present in booth during all hours of operation: <br />-------------------------- Tam Tran---------------- <br />SAN JOAQUIN <br />— COUNTY- <br />Weter <br />Owner <br />Title <br />I 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 (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Cjrccrness 5rowi he*tf. <br />I 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 4T‘F temperature): <br />□ Ice chests <br />O Refrigerated truck LJ Io <br />□ Other (specify) <br />I <br />s-iao «xi <br />Janrproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />(pv hree compartment sink. <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 />£_Z <br />Run wa«»> <br />5/5/2026 <br />Date <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov.org/ehd <br />EHO 16-02 Pago 8 oM » TEMP EVENT APP <br />06/29/2023 <br />I ke Bivgi < /<xx> CoAlwoen mil t-- H <br />thvx e of jjAiwio’ ■ <br />I Sooo druieiHnt | ---------- <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A eppy-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. I ✓ <br />Sijt^ure