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Docusign Envelope ID: 6FF94AB9-B1(J8-<W39-850D-3AF42A6'IBFAA <br />SAN JOAQUIN Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[xl Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />H One separate tub (bucket or basin) for the collection of rinse/wastewator. <br />[x] Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14. <br />DateTitleSignature <br />Health Permit <br />Paper Hand Towels <br />Cutting ttoard 1 BleachPropane Stove <br />I <br />Propane T ank <br />Bleach and Waler <br />Fire Fxtmguishcr <br />Ice Cooler <br />TEMP EVENT APP <br />Extra <br />Water <br />5 Gal I land wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping cloths <br />Booth must bo on <br />Concrote, Asphalt. <br />Plywood, ora Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slcrno wfChaffinq <br />Dish <br />5-20 Gal. <br />Handwash Water <br />3JJ <br />Extra fee Bags i rood Containers must be <br />stored 6 inches o't of the ground' <br />1 <br />Soap and Water <br />IE_z <br />Rinse Water <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 />Completed byt^S^ . <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[3 Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Dennis Young Julie Young <br />31 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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />rx] Tub to store wiping cloths in bleach solution. <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 />|x| Ice chests LI Refrigerator <br />□ Refrigerated truck D Ice bath and tubs <br />□ Other (specify) JfLiZ Ch<!Sl <br />| Soap dispenser <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />El ID 16-02 Png” 8 of 11 TC“? IT.'S* <br />07/3/17