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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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by. 14. <br />Health Permit <br />Paper Hana Towels <br />Soap dispenser <br />CuUina Board <br />Rlonchf-’ropnixr Store <br />Fee EWilinwsnw <br />TEMP EVENT APPPago 8 o< 11 <br />D U ( <br />Stcmo w.'Ctvarr.nq <br />Dish <br />>20 Gril. <br />itarrJ wash Wate* <br />Garbage <br />Can <br />Sanitizer buckri- <br />blcadh ft ««« far <br />ntoiir^j wiping ctoihG <br />Booth must ba on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Cxtm tea &19.M It Food ContMWS nwsi Co <br />stored 6 rneftos oft of tho gmund! <br />5 Gal Hand wash <br />Wastewator Container <br />/ Extra \ <br />| WMm I <br />j^lce Cooler <br />Propane Tank <br />J Rinrrc Water <br />1868 E. Hazolton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sjgovWehd <br />o-,,... n ,4 11 I tMr r:vi:rr r mEHD 16-02 Pa!J° 0 0111 <br />06/29/2023 <br />3r <br />unit > vn v v t i t <br />-COUN-Y- <br />7 <br />Soap anti WatBr <br />••Important** <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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 lce balh and tubs <br /> Other (specify)------------------------------------------------------------------------------------------ - ---------- ----------------------- <br />Names of responsible persons to be present in booth during all hours of operation: <br />______fcffrfr __________ft ..r _2_i— <br />V4 (2 »v I C-. { r. i 4-_____ <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 />— Signature/ ** Title Date