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Environmental Health Department <br />10. <br />cold holding of potentially hazardous foods below <br />11.within my booth for the sanitary cleaning of food preparation utensil Three compartment sink <br />OR <br />12. <br />13. <br />Important’ <br />14.Completed by: <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />it o <br />Propane Tank <br />LIRinse Water Bleach and Water <br />Ice Cooler j <br />1868 E. Hazelton Avenue | Stockton. California 95205 I T 209 468-3420 1 F 209 464-0138 I <br />EHD 16-02 *www.sjgov.org/ehc <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 />Sterno w/Chafting <br />Dish <br />Sanitizer bucket- <br /> bleach & water for <br />storing wiping cioths <br />Names of responsible persons to be present in booth during all hours of operation: <br />-------------------------------------------------------------------------Matt Bowden <br />SAN JOAQUIN <br />COUN * V <br />owner <br />fitii <br />09/09/2025 <br />Date <br />_z <br />Soap and Water <br />lam providing the following items <br />| • --—----- <br />Health Permit 5-20 Gai. <br />Hand wash Water <br />Fire Extinguisherm — <br />1 ldin9 .the followin9 cold temperature control for the < <br />F (|f food is 056(1 the Allowing day, maintain below 41 °F temperature)- <br />Kllcechests Refrigerator <br /> Refrigerated truck |ce path anCj |Ubs <br /> Other (specify) <br />bodB!.provld'n9 the fO"Owin9 for adedua‘e hand washing facilities, but separate from utensil wash within my <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. , , ---------------- ----------- <br />......"71 <br />Exfra Ice Bags & Food Containers must be <br />stored 6 inches otfof the ground! <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />KJ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />for SOaW wat- °"e -d one for a bleach <br />XJ Detergent, bleach, and wiping cloths (cleaning towels). <br />LI Tub to store wiping cloths in bleach solution.