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Environmentai 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 /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature <br />Health Pennit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />0IIPropane Tank <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />SiniP <br />Extra Ico Bags & Food Containers muef be <br />stored 6 Inches off of the ground! <br />Stemo wfChafTing <br />Dish <br />5 Oal Hand wash <br />Wostewetsr Gonioiiioi <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sanitizer txj cket- <br />bloeehK water for <br />storing wiping dtrths <br />SAN JOAQUIN <br />C OU l\ ' v <br />/ <br />Rinse Water <br />1868 E. Hazeton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgaiWslld <br />EHD 16-02 Page 8 of 11 <br />07/01/2024 <br />5-20 Gal. <br />Hand wash Water <br />lam 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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />Brother (specify) <br />Cutting Boazd | ----- <br />Names of responsfcle persons to be present in booth during all hours of operation: <br />__ <br />v AyAtvug CjQZlYvan ........-...---....... ..........**lmportant** Allfood 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 /> Title) Date <br />8teach and Water <br />Extra <br />Water