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► <br />SAN JOAQUIN Environmental Health Department <br />to. <br />11. <br />OR <br />12. <br /> Waler supply dispenser with warm water at a nir.ir-um c1100°F (.e. 5-2C gallon container with spigot). <br />r? One separa’e tub (bucket tv basin) for the collection of rinse/wastewater <br />n Paper towe|S and pump-stylo span ccn’airer <br />n <br />14.Completed by: <br />i-ieaitn Hermit <br />°apei hand 'owels J <br />r <br />RlnarhPropane Stove <br />< <br />Propane lank <br />P.nse Wale'Riesch end Warer <br />Fee Exiinquisher <br />■ Ice Cooler <br />Dag“ 8 nt ’1 <br />Qoner <br />tiife <br /> r <br />\L <br />I__ <br />I <br />EHD 16-02 <br />Utx 2^/2025 <br />enm lev Bags a i-ooa containers must be <br />stored 6 inches oil ot the ground' <br />Saii.wer buckel- <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphait. <br />Plywood, or a Tarp. <br />I <br />L. <br />h II <br />Sterno w.'Challing <br />Dish In <br />I <br />! <br />I~T’ <br />.’ am providing the following cold tempolalu'e control for the coltf holding of potentially hazardous foods beiow <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />l_j ice chests EL Reiitgefator <br />D Refrigerated truck • Fl Ice bath and tubs <br />Other (specify) CVC^POf \ <br />I am providing the following items within my booth for the sanitary cleaning of food preoaration utensil <br />Lj Chree compdfirnent shik. <br />C I'inUe Jeep tubs (DaSins 6-8 inches miriimum), uiie ioi ooapy water, one ior rinsing and one iot a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />Zj Eotergunt, bleach, anc w.ping cloths (Cica.iHig ivweis). <br /> Tub to store wiping cloths in bleach solution. <br />! Soap arc1 Water <br />I am providing the following for adeguate hand washing facilities, but separate from utensil wash within my <br />booth: <br />■ 5 Gal H8M wash <br />| Wasiewaie* Container <br />| Soap dispenser | <br />1868 E. Hazelton Avenue | Stockton California 95205 | T 209 468-3420 1 F 209 464-0138 | wwwsjgov.org/ehd <br />EHD 16 02 Page 8 ol ii TEMP EVENT APR <br />Names <?f responsible persons to be present in booth during al! houm epera’ion: <br />)_____________________________ _________ <br />“Important** All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparau’on for t‘ .L event. A copy of this checkiisi must be in the booth at all hours ot <br />preparation and p'peration .Return original to festival coordinator three weeks prior to <br />Gaibage i <br />Can I <br />5 20 Gal I <br />i land wash Waiei j <br />0^33 U OU <br />Rinse Watei | ' Aleacb nnrf Water I | <br />A—3