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Docusign Envelope ID: E6908F4C-CF62-4CE6-A339-7ADE9737A7D3 <br />SAN JOAQUIN Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Ex) Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />(xJ One separate tub (bucket or basin) for the collection of rinsc/wastcwatcr. <br />[x] Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Owner 4/15/202514. <br />TitleSignature Date <br />Health Permit <br />Paper Hand Towels <br />Culling Board <br />'l <br />Propane Stove <br />Oo <br />]Firn Fxlinguishcr <br />Ice Cooler <br />I <br />Soap and Walor <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />fixtrn Ice B.->gs 4 road Containots imist bo <br />stored 6 viclios oil ot the ground' <br />Slorno w/Chaffmg <br />Qiah <br />Garbage <br />Can <br />Sanitizer buckcl- <br />bleacli A water for <br />storing wiping cloths <br />Booth must bo on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />—I 5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Rinse Waler <br />1868 E. Haztillon Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcohd.com <br />f-J ID 16-02 Pago B of 11 TEMP EVENT APP <br />07/3/17 <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,Completed bv:( <br />Names of responsible persons to be present in booth during all hours of operation: <br />Jesse Collett <br />.x] 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 />I J 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 />i._] Three compartment sink. <br />| Prop.mo far* <br />Bleach and Waler <br />[ Soap dispenser | . . <br />Bleach , <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 />[xj Ice chests I I Refrigerator <br />□ Refrigerated truck I I Ice bath and tubs <br />□ Other (specify) Ice chests <br />Extra <br />Waler