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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <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 /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Health Permit <br />I papor IMnd Towels <br />Cuttmq Board <br />u,BleachPropano Stove <br />0I <br />Propano Tank <br />Bleach an.| Water <br />Ice Cooler <br />Names of responsible persons to be present in booth during all hours of operation: <br />matthew mascuzzio <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 />r«(ra Ico fi.Kjs & Feed Conlsiners must ho <br />st'jifd 6 i'ldies ull ottiio ground' <br />5 Gal 11 ind wnsh <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Sterno w Cha'lrng <br />Dish <br />Samti/or buckol- <br />bleach A waler for <br />storing wiping clolhs <br />5-20 Gal <br />Hand wash Water <br />SAN,JOAQUIN <br />C O U N T Y <br />v>' .'<11 ri (.• i s 111 t1 > ht ' C. <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 />Q Ice chests J^^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />owner <br />Title <br />7/26/24 <br />Date <br />Rinse V/aler <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <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 />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^Three compartment sink. <br />Lz <br />Soap and Water <br />y I Fro Extinguisher <br />Soap dispenser I ---------- <br />Extra <br />Water