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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 10OT (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rlnse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />14.Completed by: 4 z <br />Date <br />Health Permit <br />Peper Hand Towals <br />Sonp dlsponsor <br />Culling Bou/d <br />BloachPropans Slovs <br />Bloach anti Walor <br />Flro Exilnpuicheri <br />v <br />Signature <br />Eulre lao Baps 4 Food Conlolnots must bo <br />slotvd C hwhos otf ol Ilia groundl <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. /7 <br />Extra <br />Walnr <br />5 Gal Hand wash <br />Wastewalor Container <br />Garbage <br />Can <br />Sonltrzorbucket- <br />blnaUi & water lor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />5-20 Gal. <br />Hand wash Waler <br />Slerno w/Chaffing <br />Dish <br />Title <br />Soap end Water Rlnsa Wnlor <br />Propane Tank <br />I860 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Pago U of 11 TEMP EVENT APP <br />07/0112024 <br />Ice Cooler | , <br />“Important** <br />SANJOAOUIN <br />------COUNTY------ <br />‘•i, Grcotncss c/rov/i Iictc:. <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 />® Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___ __________________________________________________ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation; <br />hzIT