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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />03T <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Sterno w/Chaffing <br />Dish <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 />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />^3 Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />SAN JOAQUIN <br />------COUNTY------- <br />f Extra <br />Water <br />______ <br />Health Permit <br />Title <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Soap and Water <br />Date <br />□'Three com Dart fOllOtW'n iterns within mV booth for the sanitary cleaning of food preparation utensil <br />**lmportant** <br />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 />' 45°^ fond *7.?°^ te™perature contro1 for the cold bolding of potentially hazardous foods below <br />45 F (If food IS used the following day, maintain below 41 °F temperature): <br />^jlce chests Q Refrigerator <br />LJ Refrigerated truck S3be bath and tubs <br />□ Other (specify) <br />5-20 Gal. <br />Hand wash Water <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 8 of 11 TEMP EVENT APP <br />07/01/2024 <br />Thre? 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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: J <br />All food vendorfcooths 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 /> <br />< ’ Signature (j