Laserfiche WebLink
Docusign Envelope ID: 471FD30C-75C7-463B-80BE-5518212011CA <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> Ono separate tub (bucket or basin) for the collection of rinse/wastewater. <br />(3 Paper towels and pump-style soap container. <br />13. <br />‘"Important** <br />14. <br />Title DateSignature <br />1 <br />Paper Hand Towels <br />Culling Hoard <br />Piopano Stove <br />Bleach and Waler <br />Ttro Extinguisher <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Exira Ico Bags A I'ooJ Conlainors must be <br />stored 6 inches oil ol the ground' <br />Stcrno w/Chaffing <br />(W> <br />5 Gal Hand wash <br />Wastewater Container <br />Sanilizorbuckch <br />bleach A water for <br />storing willing cloths <br />---------------------------------- ■■ <br />Health Permit <br />SAN JOAQUIN <br />C r h ; xi ' v <br />| Propano Tank <br />Soap and Water Hmso Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />Jorge Avila <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I I Three compartment sink. <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 owner 4/15/2025 <br />Completed bv:| <br />[x] Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of waler). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />- <br />Garbage <br />Can <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 U Refrigerator <br /> Refrigerated truck I I Ice bath and tubs <br />□ Other (specify) Camt)ros <br />I Blench <br />1868 F. Hazellon Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjGelid.com <br />El ID 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Booth must be on <br />Concroto. Asphalt. <br />Plywood, or a Tarp. <br />____________> <br />5-20 Gal <br />Hand wash Waler <br />i) <br />| Soap dispenser | <br />Extra <br />Wntor