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Environmental Health Department <br />w <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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Pup«r Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and WalerRinse WaterSoap and Waler <br />Fire Extinguisher <br />Ice Cooler <br />TEMPEVENI APP <br />Signature <br /> Slerno w/Chaffmg <br />Dish <br />Extra <br />Walei <br />Garbage <br />Can <br />Sanitizer buckut- <br />bloach & water (or <br />slonng wiping doths <br /> Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Extra Ice Bags & Food Confine'* mjsl be <br />stoiod 6 inches off ol the ground' <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />r oi i n t \ <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 />tj^ event. <br />Title <br />Propane Tank <br />Names of responsible persons to be present in booth during all hours of operation: <br />"Important** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: / ft <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45^ (if food is used the following day, maintain below 41 °F temperature): Z//A <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _________________________________________________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil N/fir <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 /> Tub to store wiping cloths in bleach solution. <br />Date <br />1868 E Hazelton Avenue I Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sigov.org/ehd <br />EHD 16-02 Pago B of 11 TEMP EVE”’ <br />07/01/2024