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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />I <br />Paper Hard Towels <br />Soao flispenser <br />CuOing Board <br />BeacrPropane SWve <br />I <br />Prooane Tank <br />Bleach and Water <br />Fire Extircuishor <br />Ice Cooler <br />TEMP EVENT APP <br />Ste.-no WChaffirv; <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5-20 Ga'. <br />Hand wash Water <br />Saritre- bucket­ <br />bleach S water for <br />starng wiping doths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />.. -f^fwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />SAN JOAQUIN <br />------COUNTY- <br />Jlitle <br />CJ 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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />7 <br />Rinse Water <br />| Health Permit <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 dawpiaintain below 41 °F temperature): <br />^^Qlce chests ^/EJRefrigerator <br />^FfRefrigerated truck Ice bath and tubs <br />□'Other (specify)__________________________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 6 of 11 TCMP Z'.’Er.T A! <br />06^9^023 <br />rT’ L7 <br />Soap and Waler <br />Date <br />Narpes of responsible <br />"Important”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 />Z a. <br />Signature <br />EMa let Bags t Food Containers must be I ' <br />stored 6 inches off of the ground' B <br />persons to be presentin booth during all hours of operation: