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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />••Important’ <br />14.Completed by: <br />Paper Hariri Towels <br />Soap dispenser <br />Cutting Board <br />BtaadiPropane Stove <br />r <br />Prop ane Tar* <br />Bleadi and Waler <br />e <br />Ice Cooler <br />TEMP EVENT APP <br />E«tro <br />Water <br />Title <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth- <br />Slemn wChaffing <br />Dsn <br />Garbage <br />Can <br />Sanitizer bucket. <br />bleach a waler tor <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />5-20 Gal <br />Hand wash Waler <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 />5 Gal Hand wash <br />Wastewater Crxrtianer <br />SAN JOAQUIN <br />-COUNTY— <br />1 <br />Soap and Water <br />laKf providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />2j Three compartment sink. <br />Trent. <br />5flOI>. <br />Signattr^ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TC"? EVEN <br />07/01/2024 <br />Greatness grows here <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4£°F (if food is used the following day, maintain below 41 °F temperature): <br />LkMee chests [^Refrigerator <br />LJ Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />7 <br />Rhkmi Waler <br />L_j Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />L^fone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />blTPaper towels and pump-style soap container. <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for thjs-event. Azfcopy of this checklist must be in the booth at all hours of <br />preparation apdoperetlort. Fytu/n original to festival coordinator three weeks prior to <br />this evei <br />Exira let Btgs A Food Conlalntrt must bt E <br />stand 8 Inctns oft of the ground! | <br />Fire Extii'gmsber <br />| Health Permit [ <br />Names of responsible persons to be present in booth during all hours of operation: <br />