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SAN JOAQUIN Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 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 />signature <br />JHealth Permit <br />Paper Hana Towels <br />Soap Cispenser <br />Cutting Bcarfl <br />BleatnPropane Stove <br />u <br />Propane Tank <br />Bleacn ana Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <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 />0 Other (specify) _______________________________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 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 />5 Gal Hana wash <br />Wastewater Container <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />Names of responsible persons to be present in booth during all hours of operation: <br />Chris Dutra & Bethany Dutra <br />Sterno w/Chatfing <br />Osh <br />Sanitizer bucket­ <br />bleach i water tor <br />stonng wiping cloths <br />5-20 Gal <br />Hana wash Water <br />Extra <br />Water <br />J0 <br />Z <br />Soap ana Water Rinse Water <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 TZM." Z'.'E? <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 />Owner/Manager 11/25/2025 <br />Title Date <br />Exira Ice Bags I Food Containers must be <br />stored 6 inches oft of the ground1 <br />Garbage <br />Can