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U.I I V II Ml IlMI IIMMIMI <br />10, <br />11. <br />OR for rinsing and one for a bleach <br />i <br />12. <br />13.! <br />Completed by:14. <br />Health Permit <br />Paper H*nd Tcrrtrts <br />Soap dUpenser <br />Cutanc Board <br />Propao*. Slovo <br />it <br />’rooane Tank <br />Bleach and Water <br />Are Exanoublw <br />TEMP EVEN r APPPage fl oil 1 <br />OMH JUHUUIH <br />COUNTY <br />Sterno w'Choftng <br />Dah <br />5 Gal Hand wash <br />Wastewaler ConUWwt <br />Sanfflzw scrkef- <br />bieach & water tor <br />storing wiping dolhs <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp- <br />Names of responsible persons to be <br />SatTjeglv J"." <br />"•Important** <br />CfS o <br />Title <br />preparatiai <br />this event <br />I <br />Soap «>d Waler <br />5 <br />Rinse Water <br />l«w« a • <br />®s.Paper towels and pump-style soap container. <br />ms to be present in booth during all hours of operation. <br />Sh ASgc*-______________________ <br />5-20 Gai. <br />Hand wash Waler <br />[ Bkxch <br />I— <br />Ice Cooler <br />original to festival coordinator three weeks prior to <br />/o-oz-^r <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />f-) Three compartment sink. <br />0 Three deep tubs (basins 6-6 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0Jub 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 /> Water supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br />[&One separate tub (bucket or basin) for the collection of rinse/wastewaler. <br />J EjumcoB^f t. Food Containan mutt bo K <br />I siontl6M>MOlTofOtogmun<fl ■ <br />1866 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Page 0 of 11 TEMPEVENTAI <br />07/01/2025 <br />I am providing the following cold temperature contrul for (lie cold holding of potentially hazardous foods below <br />45’F (if food is used the following day, maintain below 41 ’F temperature): <br />^Ico chests L) Refrigerator <br />[□ Refrigerated truck [ZJ Ice bath and tubs <br /> Other (specify)—______ _________ <br />Garbage <br />Can <br />All food vendor booths are subject to inspection. Please make a copy of this application n <br />preparation for this event A copy of this checklist must be in the booth at all hours of <br />Signature <br />Extra <br />Water