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Environmental Health Department <br />r <br />10. <br />12. <br />13. <br />“Important** <br />14.Completed by: <br />Signature Title Date <br />Papar Hand Towels <br />Cutting Board <br />Propane Stove <br />L <br />Propane T ank <br />Bleach and Water <br />IFire Extinguisher <br />Page 8 of 11EHD 16-02 <br />06/19/19 <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer txxket- <br />oieach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Extra <br />Water <br />5-20 Gal <br />Hand wash Water <br />Stemo w/Chafting <br />Dish <br />SAN JOAQUIN <br />------COUNTY------ <br />/------------- <br />Ice Cooler <br />r3 <br />Soap and Water <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 />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 />P Health Permit <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />PHnic-Ao -------------... TEMPEVENT APR <br />Soap dispenser ______ <br />Bleach x. [ <br />3.<j0 <br />11. J am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Jj^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. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />Names of responsible persons to be present in booth during all hours of operation:_________ V7 eAw RfacfS <br />IL <br />J <br />/ <br />Rinse Water <br />Extra tee Sags 4 Food Containers must 6e <br />stored 6 inches oft of the ground'