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Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Owner <br />Title <br /> <br />9/4/24 <br />Date <br /> <br />SUBMIT <br /> <br />5-20 Gal <br />Hand wash Water <br />Propane Stove <br />Soap Shd Water <br />Fire Extinguisher <br />Rinse Water Bleach and Water Garbage <br />Can <br />Extra <br />Water <br />Ice Cooler <br />Extra ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Bleach <br />5 Gal Hand wash <br />Wastewater Container <br />REC-008 <br /> <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY-- <br />Grer.,-tr, ess grows here. <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> <br />45°F (if food is used the followin maintain below 41°F temperature): <br />4 Refrigerator Ice chests <br />efrigerated truck Ice bath and tubs <br />ther (specify) <br />11./ providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />hree compartment sink. <br />1-7 <br />OR <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />tion (one tablespoon of bleach per gallon of water). <br />I Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub 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 />FINater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />VI <br /> <br />Dne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />VI <br /> <br />paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />Alejandro Kandalaft, Maria Castillo, Armando Carbajal <br />Cutting Board <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 />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />Paper Hand Towels <br />Sanitizer bucket- <br />bleach &water tor <br />storing Wping cloths <br />"Important** <br />14. Completed by: <br />Health Permit <br />Signature <br />Sterna w/Chalting <br />Dish <br /> <br />Soap dispenser <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />END 16-02 Page 8 of 11 TEMP EVENT APP <br />06/19!19