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Environmental Health Department <br />11. <br />OR <br />12. <br />S Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />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 />Completed by: 14. <br />Signature <br />Health Permit <br />Paper HandToweh <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />Propane Tank. <br />Bleach and WaterRinse WaterSoap and Water . <br />FireExtinguisher <br />Ice Cooler . <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash: within my <br />booth: . <br />Stemo w/Chaffing <br />Disn <br />Garbage <br />Can <br />San itizer-bucket­ <br />bleach & water, for <br />storing wiping cloths <br />Extra Ice Bags &.F.oo<J Containers must be <br />stored 6 inches off of the ground! <br />5-20 Gat <br />Hand wash Water <br />SANJOAQUINWwln —COUNTY------ <br />S-res*H«*s grows iere, <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 />I3 Ice chests Refrigerator ., <br />O Refrigerated truck |3 Ice bath and tubs <br />0 Other (specify) - :: ■. <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />10. <br />0 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 />KI Detergent, bleach, and wiping cloths (cleaning towefs). <br />0 Tub to store wiping cloths in bleach solution. <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5 Gal Hand wash <br />Wastewater Container <br />Extra <br />Water <br />Names of responsible persons to be present in booth during all hours of operation:Carime Antunez <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 />thfe eyent 02/17/2023 <br />Title Date <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 j F 209 464-0138 j www.sjgov.org/ehd <br />EHD 16-02 Page 8 bf 11 TEMP EVENT APP <br />06/19/19