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Environmental Health Department•e <br />10. <br />11. <br />OR <br />12. <br />O'Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Health Permit <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />V 1 . <br />Bleach and Water <br />Fire Extinguisher <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Exrra Ice Bags & Food Containers must bo <br />stored 6 inches off of the ground! <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 eventzz?-? <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />S Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Claudia Hazelwood (7576335345), Jessica Jimenez (9852553137) <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />------COUNTY------- <br />Greoin ess gro -vs d?re. <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 />Q Ice chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Owner <br />TitleSignature <br />..... <br />Rinse Water <br />6/17/24 <br />Date <br />O’ 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />—fi Ice Cooler (; <br />^Important** <br />Propane Tank <br />-------------------------J <br /> <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page8of11 TEMP EVENT APP <br />07/3/17 <br />I <br />Soao and Waler