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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />H Raper towels and pump-style soap container. <br />13. <br />14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />&Fire Extinguisher <br />£ <br />Ice Cooler <br />zx <br />EHD 16-02 <br />06/19/19 <br />S 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 />Stemo w/Chafling <br />Dish <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />John Wall or Frank Teixeira <br />Extra Ice Bags A Food Containers must be <br />stored 6 Inches off of the ground! <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />SAIWOAOUIN <br />-COUNTY- <br />5-8-25 <br />Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pages of 11 TEMP EVENT APR <br />**lmportant**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. <br />Completed by: John wail <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />!■] Three compartment sink. <br />' th8 fo"°“'in9 ,“ld temperature control for the cold holding of potentially hazardous foods below <br />4o r (if food is used the following day, maintain below 41 °F temperature): <br />CZ] Ice chests Refrigerator <br />B Refrigerated truck Ice bath and tubs <br /> Other (specify)____________ <br />Member <br />Title <br />^arr^ providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> 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 />LU Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />/ : LT^777 <br />Soap and Water Rinse ater