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Garbage <br />Can <br />Bleach arid Water <br />Benny Martinez Owner <br />Signature Title <br />Soap dispenser <br />1/31/24 <br />Date <br />Paper Na,,,) Towels <br />Sanitizer bucket- <br />bleach & water tor <br />sloring wiping cloths <br />Completed by: <br />Health Permit <br />Senor <br />Dish <br />Culling Board <br />I propane Stove <br />5-20 Gat. <br />Hand wash Water <br />Ice Cooler <br />Extra Ice Bags & Food Containers must be <br />stored Cinches off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Fee Extinguisher <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SANtIOAQUIN <br />CM l•.11-v. <br />Environmental Health Department <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 />LI Ice chests [S1 Refrigerator <br />0 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 />M 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 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 />2 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />RI Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Benny Martinez & Nina !Martinez <br />'Important 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 this event. <br />1668 E. Hazeiion AN.,eni:aj Siockton, CPliccrtiiw. 95205 j T 239 433-3A,20 209 -G4-0130 EHD 16-02 Page 8 of 11 TEMP EVENT APP 0612912023 <br />OR