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Environments! Health Department <br />10. <br />□ ice bath and tubs <br />it. <br />OR <br />12. <br />f~j Water supply dispenser with warm water at a minimum of 100°F (Le. 5-20 gallon container with spigot). <br />□ O;iparate tub (bucket or basin) for the collection of rinse/wastewater. <br />'aper towels and pumo-styte soap container. <br />13. <br />important** <br />14.Completed by: <br />■Otte <br />1Health Permit <br />t'apv Hard TtrwrlS <br />Ctftlrxj &»r-0 <br />S»eaCTiFrooaneSfflvB <br />u <br />PnaaneTanX <br />Ffre &®ngU«F!w <br />Ice Cooler <br />lai <br />FT} <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 cioths (cleaning towels). <br />O 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 />froviding the foltowing items within my booth for the sanitary cleaning of food preparation utensil <br />iree compartment sink. <br />S&sm«^Cha!5^ <br />OisM <br />5 Ga! Hsftd wash <br />Wsstewsler Corfainer <br />Booth must been <br />Concrete. Asphaft <br />Plywood, or a Tarp. <br />■ ■ ■ i <br />SffiS&zet iyjcket- <br />tioach & watijr for <br />sforfo^ wfofcig d oBw <br />•■a <br />5-20 G£t <br />Hand wash Winer <br />SAN JOAQUIN <br />—- COUNTV----- <br />f Enra ’ <br />water <br />- I <br />Soap anti Wirier <br />/ <br />Rfcse Water <br />sOi Signature <br />l;.2i>£3CT5'?lP5<2£i <br />Ex&f tc* Bogst Fo&JC&i&m uvsi Id <br />sfDrifd 6 indrss off of Sit $vwd? M <br />Names of responsible petjsons to be pre: <br />_______ Clrrp/>|/% <br />be present in bpoth during all hours of operation: <br />I am providing the following cold temperature control tor the cold holding of potentially hazardous foods below <br />45’F (if food is used the following day, maintain below 41 °F temperature): <br />□ tee chests <br />0 Refrigerated truck <br />□ Other (specify) <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 />U Ha-wav <br />Title U Dbte v <br />Gsrbas« <br />Can= I- <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EHO16MJ2 Page 8 of 11 TEM3 EVENT APR <br />05f29Z2025