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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 /> 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 />o <br />Health Permit <br />1 Paper Hand Towels <br />Cutting Board <br />iPropane Stove <br />Propane Tank <br />’ JI Piro Extinguisher <br />Ice Cooler <br />Extra /co Bags ft Food Con'o/nors mt’S( bo <br />storod 6 Inchon off of Ifie ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />Stemo w/Chafflng <br />Dish <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />SAN JOAQUIN <br />GOUK' <br />/GA <br />Water <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 />itle 'Dalfe <br />/ <br />Rinse Water <br />Names of responsible persons to be present in booth during all hours of operation: <br /> ____I cU I ________ <br />"Important* <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 />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />J <br />Soap and Water <br />1 a.T.??y!tdin9 the followin9 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 />v— Hand wash Waler <br />Soap dispenser --------- - \ <br />Bleach . <br />EaUiUu <br />Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | ^^jaoroo^^ <br />EHD 16-02 Page 8 of 11 <br />07/01/2024