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10. <br />11. <br />OR <br />12. <br />13. <br />/ArCompleted by: 14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />ft <br />Bleach and WaterRinse Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extn la.- Bags & Food Containers must be <br />stored 6 inches off of lhe ground! <br />5 Gat Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterna w/CIWfing <br />Dish <br />----- <br />SANJOAOUIN <br />Propane Tank <br />[^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13-38 E. Hazelton Avenue | <br />EHD 16-02 <br />07/01/2024 <br />Stockton, California 95205 | T 209 468-3420 5 F 209 464-0138 | vvww.sigovTjig/ehd <br />Page8 of 11 •*.> <br />i <br />** Important** <br />Environmental Health Department <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <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 />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 />[^Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___ _____________________ <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 />.......-z ’ <br />v T ! ~ <br />Soap and Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Title <br />5-20 Gai. <br />Hand Wash Water