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SAN JOAQUIN Environmental Health Department <br />10 <br />11. <br />OR <br />12. <br />One separate tub (bucket or basin) for the collection of rinse/wastewater <br />Paper towels and pump-style soap container <br />13.Names of responsible persons to be present in booth dunng all hours of operation . . <br />5Vlt4i2 , T&IThl SCOTT <br />“Important** <br />Completed by:14. <br />Health Permit <br />Paper Hand 1 owvls <br />S<up disponMM <br />Propane Stove <br />0 <br />Propone Tank <br />Bleach and Water <br />I io txluiQU'JMrc <br />Ice Cooler <br />f *tra fee Bopj i Food Conliuiai must Im <br />shitt^i 6 nchos o« al the gtvund1 <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 />St«r»> w/Chatfino <br />Osh <br />L»tra <br />Watw <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />5 Gol Hand wash <br />WaUuwatvr Containor <br />| Bleach <br />I 0UVV-----? <br />'Signature Title Date <br />5 20 Cal <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />^H’Water supply dispenser with warm water at a minimum of 100°F (i e 5-20 gallon container with spigot) <br />1 ar"cprovidin9 the following cold temperature control for the cold holding of potentially hazardous foods below <br />4y>(if food is used the following day, maintain below 41 °F temperature) <br />0Tce chests Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) <br />1868 L Hazelton Avenue | Stockton California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/01/2024 <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />LI Three compartment sink. <br />^^frhree 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 />^M^Dptergent, bleach, and wiping cloths (cleaning towels) <br />ub to store wiping cloths in bleach solution <br />Sanitizor bucket <br />Hooch & watvi lot <br />ctoung wiping dothi <br />r~z <br />Soap and Watw R<nw Watix <br />Cuding Bond