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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />14.Completed by: - <br />Signature <br />Health Permit <br />I Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />I <br />Propane Tank <br />Bleach and WaterRinse Waler <br />!Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />riaSKik <br />All food vendor booths ere 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 />Stemo w/Chaffirtg <br />Dish <br />Garbage <br />Can <br />Sanitizer buckat- <br />bloach & water for <br />otoring wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra Ice 4 Food Conraftwre mutt M <br />stored 6 Inches oft ot the ground! <br />S Gai Hand wash <br />Woatowotcr Contain* <br />SAN JOAQUIN <br />COL1 K - v <br />( Exira \ <br />Water <br />Title <br />••Important** <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />1868 E Hazelton Avanue | Stockton, California 95205 I T 209 468-3420 | F 209464-0138 J www.sjgovto>W>d <br />Dana fl nf 11 TEMP CVCNI AlEHD 16-02 page it or ii <br />07701/2024 <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />'CjWater supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />\Z5one separate tub (bucket or basin) for the collection of rinse/wastewater. <br />xE^Paper towels and pump-style soap container. <br />Soap and Waler <br />1 temPerature “"koi for foe cold holding of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41 °F temperature): <br />0lce chests Refrigerator <br /> Refrigerated truck ice bath and tubs <br />O Other (specify) <br />Piro Exlinauiaher <br />5-20 Gal. <br />Hand wash Waler <br />M <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />(ZfThree 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 />{ZLDetergent, bleach, and wiping cloths (cleaning towels). <br />'0 Tub to store wiping cloths in bleach solution.