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Environmental Health Department <br />11. <br />OR <br />12. <br />L] Paper towels and pump-stylo soap container. <br />Names of rcsponsibh13. <br />14. <br />Title <br />f’iiper Hand Towels <br />Soap dispenser <br />I’ropnno Stove <br />Hinsn Water <br />^£1 <br />Sanitizer birckol- <br />blcach X water lor <br />slot irxj wiping cloltis <br />Storno wfChalling <br />Dish <br />Garbage) <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />J^VVater supply dispenser with warm water at a minimum of 100°f; (i.e. 5-20 gallon container with spigot). <br />[J One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />IS <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), ono 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 />[J Tub to store wiping cloths in bleach solution. <br />| I'lniMno <br /> Booth must be on <br />Concrete, Asphalt, | <br />Plywood, or a Tarp. <br /> J J Bk.-.ich nnd W.Ttof | <br />( Pxtra \ <br />Water <br />“Important** <br />( tllp.icll <br />SANJOAOUIN <br />------COUNTY------- <br />Greatncss grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4{5°F (if food is used the following day, maintain below 41°F temperature): <br />foflce chests Refrigerator <br />I l Refrigerated truck Q Ice bath and tubs <br /> Other (specify)_____________________________ <br />s <br />/. . <br />Ice Cooler <br />s of rcsponsi^^^ons to be present in booth during all hours of operation: <br /> Soap nnd Watnr | <br />fire extinguisher j <br />1868 F. Ila/olton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/chd <br />1:110 Ki 02 Page 0 of 11 T( Ml* liVI N I APP <br />06/29/202.3 <br />I xl/:i len lings & I nod Containois must bo K <br />stored (i mchas off o! thn ground' |'3 <br />10. <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 al all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />Completed by: dtd/W/-. <br />[/ Signature <br />Cutting tto.ird I <br />5 Gul I kmd wash <br />Wastewater Container I <br />I Health Permit