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Docusign Envelope ID: ED22E908-7163-4143-A00D-17BA'18EO399B <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[3 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14. <br />Title DateSignature <br />Health Permit <br />1 Paper Hand Towels <br />Culling Board <br />Propane Stove <br />fl <br />Propane far* <br />Bleach and Waler <br />Uro Extinguisher <br />Ice Cooler <br />0 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[U Three compartment sink. <br />Stcrno w.'Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer buckot- <br />bleach A water for <br />storing wi|kng cloths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />t • i, • >. < "!’• <br />l-rlra Icc Bags 41 ami Cont.wicts must be <br />stored 6 inches oil of the ground! <br />Garbage <br />Can <br />5-20 Gal. <br />Hand wash Water <br />> , i. - .ii <br />SAN JOAQUIN <br />Booth must bo on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Rinse Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcetid.coin <br />EHD16-02 PagoBotll TEMPEVENT APR <br />07/3/17 <br />Names of responsible persons to be present in booth during all hours of operation: <br />Brian Paris and Larry Paris <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 />□ Tub to store wiping cloths in bleach solution. <br />r7 <br />Soap and Water <br />| Soap disponsor | <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 />r -this event C00k 4/15/2025 <br />Completed by:| <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 LxJ Refrigerator <br />□ Refrigerated truck Fl Ice bath and tubs <br />□ Other (specify) Catntjro_______________________________ _______ _____ ___________________ <br />| Blcadi <br />Tht