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10. <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />Completed by: 14. <br />^Signature <br />Paper Hsod Tov-els <br />Soap diiponior <br />Cutlirfl Board <br />BlnachPropane Stovv <br />X Bloa«i and V.'aJer <br />fire Ertorjuishnr <br />! <br />TEMP EVENT APP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 ^04ce bath and tubs <br /> Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5 Gul Hund wash <br />Container <br />Garbage <br />Can <br />Snnitizcr bucket- <br />Mearii S water tor <br />staring wiping <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SWmn wiChnKvog <br />Disli <br />Health Permit <br />cq Cooler <br />' Extra \ <br />Water I <br />Odra ft.ti fi^s & Food Ccvifauiers must bo <br />storod 6 xnebos off of tho gmuodf <br />“Important* <br />7 <br />Soap and v/.-ilcr <br />Propane 1 ank <br />•a’/ <br />tn <br />Rmsc Walar <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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-0? Page 8 of 11 TZ.*" CVCJ.T .*J <br />0ef2S/2023 <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />JkI Paper towels and pump-style soap container. <br />Names of <br />M n i i j vnv/v i i t <br />COUN-v <br />&20 Gal. <br />r- Hand wash Waler <br />of responsibly persons to be present in booth during all hours of operation:fl, ___________________ <br />y n c L ) f r <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 />thispyenL . I n e <br /> <br />Title Date