Laserfiche WebLink
Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />utensil wash within my <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />Soap and Water Rinse Water <br />Fire Extinguisher <br />J <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Stemo w/Chafflng <br />Dish <br />1868 E. <br />EHD 16-02 <br />06/19/19 <br />1 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />° TEMP EVENT APP <br />Ice Cooler w <br />[ Extra <br />I Water <br />Signature <br />Names of resp^b^>er^^° be^present in booth during all hours of operation: <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />__________________- J <br />Hazelton Avenue | Stockton, California 95205 | ~ <br />Page 8 of 11 <br />□ Th7ee compartmenrsink^"15 b°Oth San'tary Cleanin9 of food PrePara«°n utensil <br />**lmportant** <br />SAN JOAQu.N <br />-COUNTY <br />Vir-.1.)? fh ‘ii ow, ht’re <br />1 “ets“■ ““ <br />Ice chests Q Refrigerator <br /> Refrigerated truck g] Ice bath and tubs <br /> Other (specify) <br />Extra Ice Bags & Food Containers must be <br />stored 6 Inches off of the ground! <br />KI 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). 9 aCh <br />K Detergent, bleach, and wiping cloths (cleaning towels). <br />K Tub to store wiping cloths in bleach solution. <br />xx —Jl I <br />KI Water supply dispenser with warm water at a minimum of 100"F (i.e. 5-20 gallon container with spigot). <br />KI ®ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />KI Paper towels and pump-style soap container. <br />booth.Pr0Viding the followin9 for adequate hand washing facilities, but separate from <br />| Health Permit <br />"TF IT J O l';’ ...7 . .... <br />All food vendor booths are subject to inspection. Please make a copy of this application’in <br />preparation^d o^toni Retom original ^ofest^coortinator three w^ekL pTr to <br />Owner Q4/10/2023 <br />Title Date