Laserfiche WebLink
Environmental Health Department <br />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 />/ <br />Completed by:14. <br />Health Permit <br />Pape, HjrxJ Toweis <br />Soap dispon*er <br />Cutnp Board 3 {BisachPropW* Stov* <br />I <br />Propane Tan* <br />Bleach and Water <br />Pre Extmgureher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood or a Tarp <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater <br />D Raper towels and pump-style soap container. <br />Siemo w)Cbaff>HQ <br />D.»h <br />5 Gal Hand •ash <br />Wastewater Container <br />Sarufczw ixx*at- <br />tSaach & wafer "cr <br />sxery wipng defT’S <br />SAN JOAQUIN <br />-COUNT Y- <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods be.ow <br />45OF (if food is used the following day. maintain below 41 F temperature) <br /> Ice chests Refrigerator <br />O Refrigerated truck Q.k'e bath and tubs <br /> Other (specify)_____________—------------—-------------------- <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />EHD 16-02 Pa9® 8 0,1 ’ -’-"T *- <br />07/01/2024 <br />Signature <br />D U OLs <br />5-20 Gat <br />Hand «Mh Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[ZJ Three compartment sink. <br /> Three deep tubs (basins 6-6 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 /> Determent bleach and wiping cloths (cleaning towels) <br />S 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 />5 <br />Rln»« Wale' <br />I [>fa !a> Hags 4 food must M R <br />6 mcMs off of tf-G giouna' 13 <br />Names of res^nsibtepersons,to be^^r^s^it in txx^h dunng^ll^h^urs of operation: <br />ANlKA ^oOAVA^nir______________ <br />-Important** All food vendor booths are subjecf 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 /> ulodws <br />Title Da$ T <br />Soap and Water <br />Extra <br />Water