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k <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />**lmportant** <br />m original to festival coordinator three weeks prior to <br />14.Completed by: <br />Health Permit <br />]Paper Hand Towels <br />Sow dispenser <br />Cuttlnfl Board <br />BleachPropane Stove <br />0J1 <br />Propane Tank <br />JI Bleed) and WaterRinse Water <br />Fire Extinoulshor <br />Ice Cooler <br />TEMP EVENT APP <br />•ZHTi <br />Slemo WQiaffing <br />Dish <br />5 Gal Hand wash <br />Wostcwotor Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra he S Food Containers muM ba <br />tltmd 6 hchaa ottoftho ground! <br />SsniSzer bucket­ <br />bleach 4 water for <br />storing wiping doths <br />Title <br />SAN JOAQUIN <br />COUK-v <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. Retui <br /> <br />Signatory <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 Of 11 TEMP EVENT A! <br />07/01/2024 <br />,3.«yy3£~ <br />Date <br />l^am^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />tfwater supply dispenser with warm water at a minimum of 100°F (i.e. 6-20 gallon container with spigot). <br />0*6ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />HfPapertowels and pump-style soap container. <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 />1 ToPT?’09 the followln9 cold temperature control for the cold holding of potentially hazardous foods below <br />45^F (if food is used the following day, maintain below 4VF temperature): <br />Hlcechests Q Refrigerator <br />□ Refrigerated truck ©Ice bath and tubs <br />□ Other (specify) <br />lam providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />___L <br />Soap and Waler