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Environmental Health Department <br />10. <br />/a <br />11. <br />OR <br />12. <br />13. <br />Completed by:14.Date <br />Health Permit <br />Paper Hand Towals <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />f- <br />Bleacti and Water <br />Fire Exltnoulsher <br />Q <br />Ice Cooler <br />Page 8 of 11 <br />Soap and Waler Rinse Water <br />Eiitra let BtQi & Food Conltlntrt mutt Oe <br />stored fl inches olfoltht ground/ <br />5 Gal Hand wa»n <br />Wastewater Container <br />5-20 Gal <br />Hand wash Waler <br />Garbage <br />Can <br />Samhier bucket­ <br />bleach & water lor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chaffmg <br />Dish <br />OvV/Jd/L. <br />Title <br />Propane Tank ________> <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16 02 Pa00 8 0,11 TEMP EVENT APP <br />07/01/2024 <br />k! <br />Bleach x, <br />obo <br />I am providing the following for adequate hand washing facilities, but <br />booth: <br />skater supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br />H'one separate tub (bucket or basin) for the collection of rinse/wastewater. <br />"Important’” <br />SAN JOAQUIN <br />COUNTY---- <br />Grrotness qroivs here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods be <br />45°F (if food is used the following day, maintain below 41°F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify). <br />separate from utensil wash within my <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />---------------------- <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />for this event A copy of this checklist must be in the booth at all hours of preparation Ind operationi Return original to festival coordinator three weeks prior to <br />Signature <br />I apYproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />M Three compartment sink. <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution.