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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Paper towels and pump-style soao container. <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleashPropane Stove <br />0: <br />Rinse Water Bleach and Water <br />Fire ExSnpuishora <br />Ice Cooler _________________ <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Extra <br />Water <br />.............................................. - ......................................./ ■: :■ ", <br />Extra Ico Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Title <br />Propane Tank <br />-------------------------J <br />c2.o^-5 <br />Date <br />7 <br />Soap and Water <br />______, 3cqT i <br /> <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 n « <br /> <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />z0zThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />soliton (one tablespoon of bleach per gallon of water). <br />^0Detergent, bleach, and wiping cloths (cleaning towels). <br />^Q^ub to store wiping cloths in bleach solution. <br />I arn^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />^Q'Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />zEfOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />' SANJOAOUIN <br />------COUNTY------ <br />Greatness grOns here. <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 />^0lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Names of responsible persons to be present in booth during all hours of operation: <br />MowC ScoT i KcJ'TH i <br />"Important** <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 PagsBofll TEMP EVENT APR <br />07/01/2024