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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />Health Permit <br />Paper Hariri Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />it <br />Bleach and Water <br />Fire Extinguisherfl <br />Ice Cooler <br />Garbage <br />Can <br />Stemo w ChaffingDish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitl.'Hr bucktrt- <br />bleadr & water for <br />storing wiping doths <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness <br />(Go -Cx>5 <br />Title <br />Propane Tank 1 I <br />Soap and Water Rinse Water <br />Extra Ice Bags rt Food Containers must bo I <br />stored 6 inches oft of the ground! <br />’’Important' <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />XL 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 />EJ Tub to store wiping cloths in bleach solution. <br />grows 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 />Ice chests Refrigerator <br />□ Refrigerated truck Ice bath and tubs <br />□ Other (specify)^ <br />5-20 Gd. <br />r- Hund wash Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | wwvy.sjgov.org/ehd <br />EHD 1&-02 Page 8 of 11 TEMP EVENT APP <br />07'01/2024 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />------- A <br />Booth must be on < <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Mwater supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />KLOne separate tub (bucket or basin) for the collection of rinse/wastewater. <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 />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and opcrajron. Return original to festival coordinator three weeks prior to <br />Completed by: G<D <br />fiighature Title Date7