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-i—ice Cooler <br />Stern° wiChaffing <br />Dish <br />Euro Ice flogs 6 Food Con/mows m0011,0 <br />stoned 6 Inches off of the ground/ <br />5-20 Gal. <br />Hand wash Water <br />Paper Hand Towels <br />Sanitifor bucket- <br />bleach & water for <br />stonng wiping cloths <br />Health Permit <br />Cutting Board <br />Rinse Water Bleach end Water <br />Soup dispenser <br />Propane Stove <br />L_J I <br />Soap and Water <br />Fire Extinguisher <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Water <br />Garbage <br />Can <br /> <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />Jitii..ss ()v.'s heft:. <br />10. 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 41°F temperature): <br />D Ice chests KI Refrigerator <br />[X Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />D 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 />D Detergent, bleach, and wiping cloths (cleaning towels). <br />El Tub 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 />X Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />X One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />X Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />uis Ramos <br />"Important** All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for his event. A copy of this checklist must be in the booth at all hours of <br />preparation • •dera o V turn original to festival coordinator three weeks prior to <br />Completed by: <br />this even <br />ignature <br /> <br />Owner <br />Title <br /> <br />4/5/23 <br />Date <br /> <br />OR <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />Pun iP_n? D.... 5 .1 ii trimrt,r,Ir Ann