Laserfiche WebLink
Docusign Envelope ID: 9A7BE01D-FC99-85AB-8268-882A442566E3 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Ex! One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />“Important** <br />4/20/202614. <br />TitleSignature Date <br />Health Permit <br />Paper Hana Towels <br />Soap dispenser <br />Cutting Board 2 A <br />BleachPropane Stove <br />I <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Names of responsible persons to be present in booth during all hours of operation: <br />Brian and Liz Silveira <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Q 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 />[J Tub to store wiping cloths in bleach solution. <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 />0 Ice chests Refrigerator <br /> Refrigerated truck Q Ice bath and tubs <br /> Other (specify)____________________________________________________________ <br />Extra Icc Bags S Food Containers must De <br />stored 6 inches otf ot the ground1 <br />5 Gal Hand wasn <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer Bucket- <br />bteacn & water tor <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />COUNTY <br />0 <br />JoIce Cooler <br />[ <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 />Completed by: <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 TEMP EVENT APR <br />07/01/2025 <br />EC_Z <br />Rinse Water <br />rr LJ <br />Soap and Water