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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />7?Completed by: 14. <br />Signature <br />Health Permit <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stave <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />TEMP EVENT APRPage 8 of 11 <br />5 Gai Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Sanitizer bucket- <br />Heach & water for <br />storing wiping ctoths <br />Stemo vtfChaffing <br />Dish <br />I am <br />a <br />Names of responsible pers^s is to be preseflf in boothsfibring all hours of operation: <br />\ v v r LLfriV <br />**lmportant** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />boothi- <br />f/fwater supply dispenser with wami water at a minimum of 100DF (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[zfpaper towels and pump-style soap container. <br />Extra Ice Bags S Food Containers must be <br />stemd 6 indies off of the ground! <br />jyf;________________________________________ <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 Al <br />06/29/2023 <br />Ice Cooler <br />i, <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 /> <br /> <br />5-20 Gal. <br />V~ Hand wash Water <br />SAN JOAQUIN <br />------COUNTY— <br />G"£-2irtss qrows here. <br />ividing tire following cold temperature control for the cold holding of potentially hazardous foods below <br />F (if food is used the following day, maintain below 41 °F temperature): <br />ZJlce chests O^tefrigerator <br /> Refrigerated truck 0 Ice bath and tubs <br /> Other (specify) ____________________________________ <br />—J I = <br />& <br />.Pw? <br />Soap and Water <br />Extra <br />Water