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Environmental Health Department <br />10. <br />11. <br />OR <br />I <br />12. <br /> 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 />13. <br />Completed by:14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Bleach <br />Propane Stove <br />7^I <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />5 Gaf Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Ex&3 Ice Bags & Food Containers must be rl <br />stored 6 inches off the ground} [■ <br />Stsmo wtChaffing <br />Dish <br />Extra <br />Viaus <br />Sanitizer bucket- <br />bteach & water for <br />storing wiping cloths <br />Propane Tank <br />Cutting Board ------- - <br /> l ■ _I< .1...., . <br />I® <br />Names of resporusible persons to be <br /> <br /> <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event, <br />preparation and operation^ <br />this eyetfe)*? <br />Signature <br />**lmportant**A copy of this checklist must be in the booth at all hours of <br />IRetum original to festival coordinator three weeks prior to <br />CWwr Q,\ \\'I.OZA- <br />Title Date <br />Paper towels and pump-style soap container. <br />i present jn booth during.all hours,of operation: . <br />Avce^na! vafaVQ- Glared ) <br />- i SAN JOAQUIN <br />------COUNTY------ <br />gra.^s hc.-e. <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 R^ngerator <br />Q Refrigerated truck LJ Ice bath and fobs <br /> Other (specify) _ ____________________________ _________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^g/ehd <br />EHD 16-02 PageSofll <br />06/29/2023 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />XI 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 />XI 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 />Soap and Water Rinse Water