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SAN JOAQUIN Environmental Health Department <br />10. <br />N/A <br />11. <br />OR <br />12. <br />[x] Water supply dispenser with warm water at a minimum of 100°F (i.c. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Soap disponsor <br />Cutting Board <br />BleachPropane Stove <br />0 <br />Propane lank <br />Bleach and WaterRinse Water <br />Flro Extinguishor <br />Ice Cooler <br />Names of responsible persons to be present in booth during all hours of operation: <br />TRACY HOOD <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41°F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />0 Other (specify) <br />I ttra tea (Ings A Coml Containers must bo <br />storod 6 inchos of! ol tho ground' <br />Slcfno w/Chaf(|ng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewaler Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />Storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />N/A <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />5-20 Gal <br />Hand wash Water <br />OWNER <br />Title <br />8/14/24 <br />Date <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 />Signature <br />1868 F Hazelton Avenue | Stockton, Calilorma 95205 | T 209 468-3420 | F 209 464-0138 | wwwsjcohd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />_z <br />Soap and Water