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SAN JOAQUIN 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 />J^Paper towels and pump-style soap container. <br />13. <br />‘"Important** <br />Completed by: 14. <br />DateSignature <br />Health Permit |3 <br />Paper Hand Towels <br />Soap disponsor <br />Culllnn Board <br />BleachPropane Stove <br />Z 0T <br />Propane T ank <br />Bleach and Waler <br />Fire Extinguisher <br />TEMP EVENT APP <br />i Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />Stcrno w/ChaHing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wasli <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 />Names of responsible persons to be present in booth during all hours of operation: <br />WILL VON PERTZ <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 />5-20 Gal. <br />I land wash Water <br />CEO <br />Title <br />Exfra /co Bags i Food Containars must bo <br />stored 6 inchos otf o! tho ground! <br />7 <br />Rinse Water <br />'ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.coin <br />EHD 16-02 Page 8 of 11 TEMP EVENT <br />07/3/17 <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 7/20/24 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />^0 Three compartment sink. <br />_z <br />Soap and Water