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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.BrnnV^aXez&NTna PMartin"dUrin9 a" h°urs °f opera,i°n: <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hanu Towels <br />Culling Board <br />Propane Stova Bleach <br />n <br />Propane Tank <br />Bleach and Water <br />Fire Exllnguisher <br />K Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 galli <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Slemo w/Challing <br />Dish <br />5 Gal Hand wash <br />Waslevratcr Container <br />5-20 Gai. <br />Hand wash Water <br />Garbage <br />Can <br />Sanilizer bucket- <br />bloach & water lor <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br />Entrp lea Bags & Food Contoinors must be <br />stoied 6 inches on of the ground! <br />SAN JOAQUIN <br />■ " COUNTY- <br />/ Extra ' <br />Waler <br />Soap and Water <br />j Ice Cooler <br />Owner <br />Title <br />sb7 <br />Rinss Water <br />Ion container with spigot). <br />"Important** <br />^®^_Haze,tonAvenue| Stockton. California 95205 | T 203 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06/29/2023 Pa!,e 8 °f 11 TEMP EVENT APR <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />L23 Three compartment sink. <br />1 the followin9 cold temperature control for the cold holding of potentially hazardous foods below <br />45 r (if food is used the following day. maintain below 41 °F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck |Ce bath and tubs <br /> Other (specify)_______ __________ <br />Soap dispenser <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 />Benny Martinez Owner <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: ■'