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IHealth Permit I <br />I Cutting Board I <br />5-20 Gal. <br />Hand wash Water <br />HP dispenser I <br />Rinse Water <br />Eret-.\\ra <br />Water <br />Bleach and Water <br />Paper Hand TOW, i5 <br />Sanitizer bucket. <br />bleach & water for <br />storing wiping cloths <br />i <br />Ice Cooler <br />Propane Stave <br />C=-.1 I <br />Soap and Water <br />Sterna w/Charfing <br />Cish <br />iiMENNNEMEMBW --7-- <br />Edsa ke Bags & Food ConiaMers must be <br />stored 6 itches off at the gmtncb <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastevrater Cordainer <br />SAN JOAQUIN <br />Environmental Health Department <br />- 0 1\1 — v - <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 41°F temperature): <br />El Ice chests El Refrigerator <br />D Refrigerated truck D Ice bath and tubs <br />El 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 />El 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 petergent, bleach, and wiping cloths (cleaning towels). <br />10,7ub to store wiping cloths in bleach solution. <br />12. 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 />1126ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />A rr-jcr: <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 />pre ration and operation. Return original to festival coordinator three weeksi rior to <br />thi event <br />Signature <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 6 011 TEMP EVENT APP <br />06/29/2023 <br />OR <br />*important** <br />Completed by: <br />Title Date <br />Scanned with CamScanner