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Docusign Envelope ID: 94735839-8778-4439-B749-D81B9A1E9498 <br />Environmental Health Department <br />10. <br />Cold box <br />11. <br />OR <br />12. <br />lx] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />lx] One separate tub (bucket or basin) for the collection of rinso/wastcwatcr. <br />[x] Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed bv:( Mu-P eftf14. <br />TitleSignature Date <br />Health Permit <br />Paper Hand Toweh <br />Cutting Board <br />iPropano Stove <br />Propano Tai* <br />Fire ( xtlnguistior <br />Ice Cooler <br />Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Fxlrn lea Hags X I'ood Containers must ho <br />stored 6 inches oil ol the ground1 <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping clollis <br />5 Gal Hand wash <br />Wastewater Container <br />Slcmo wrChaffing <br />Disli <br />5-20 Gal <br />Hand wash Water <br />— <br />SAN JOAQUIN <br />t" OU N I <br />Booth must bo on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Soap and Waler <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 below41°F temperature): <br />[x] Ice chests IxJ Refrigerator <br />□ Refrigerated truck I 1 Ice bath and tubs <br />□ Other (specify) C°^ ^°X __________ <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 />> ibis event. owner 4/16/2025 <br />Garbage <br />Can <br />Names of responsible persons to be present in booth during all hours of operation: <br />Parker Estep <br />fx] 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 />GJ 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 />Q Three compartment sink. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 200 464 0138 | www.sjcehd.com <br />EHD 16-02 Pago 8 of 11 TEMP EVENT APP <br />07/3/17 <br />[ Rloach and Water <br />[ Exira <br />Water