Laserfiche WebLink
Docusign Envelope ID: A6F36A60-089C-4606-AB67-DB866ABAE8DC <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> £aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation gary bianco and gull ann bianco <br /> <br />13. <br />**lmportant** <br />DocuSIgntd by: <br />4/29/2025owner14.Completed by: <br />Title Dateiturenr <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APR <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />hand wash sink in food truck <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <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 />H Detergent, bleach, and wiping cloths (cleaning towels). <br /> 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 />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <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 />Sterno w/Chaffing <br />Dish <br />Exira <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br /> Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Water <br />atness grows here. <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 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />SAN JOAQUIN <br />------COUNTY— <br />Gr <br />Rinse WaterSoap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />1 — „ r . . T-r“a>r”» r-' /hut a i <br />EHD 16-02 Page 8 of 11 •— ••• <br />07/01/2024