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-si <br />Environmental Health Department <br />•S-r.; <br />10. <br />11. <br />OR <br />I <br />12. <br />13. <br />14. <br />Health Permit f <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />TEMP EVENT APR <br />5 Gat Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />Stemo w/Ghaffing <br />Dish <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />E <br />Soap and Water <br />N^i <br />|s>£ <br />l^m providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />EAThree compartment sink. <br />g^T^ee deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sqjutfon (one tablespoon of bleach per gallon of water). <br />l/jDeforgent, bleach, and wiping cloths (cleaning towels). <br />□jfjb 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 />Skater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Elone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q^aper towels and pump-style soap container. <br />“Important** <br />ies of responsiblepersons to be present in booth during all hours of operation: <br />SANJOAOUIN <br />------COUNTY------ <br />hers. <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 />Rf Ice chests □Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />O Other (specify)_ _____________________________________________ <br />Ice Cooler p <br />=4^ <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 />Cnn^by: TIiKM <br /> <br />' C ^kjhature Title Date <br />[ T Exria foe Bags t Food Containers mist be <br />...................... ■—stored fineries off of the ground! <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420} F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TE"'P - —" A' <br />06/29/2023