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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />S Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />14.Completed by: <br />sig.in <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stovo Bleach <br />Piro Extinguisher <br />Ice Cooler <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Slemo w/Chatf ng <br />Dish <br />5 Gal Hand wash <br />Waslewaler Container <br />Garbage <br />Can <br />Sanitize- bucket- <br />Wcach 8 water (or <br />storing wiping ciolhs <br />6-20 Gal. <br />Hand v/ash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />( Extra \ <br />Water <br />Owner <br />Title <br />02/18/26 <br />Date <br />-J <br />■ • <br />czj i Lb __I I ~ <br />Rinse Water <br />r.L—z <br />Soap and Water <br />/ Extra Ice Bags & Food Containers must be <br />------------------------------- stored 6 inches ot! of the gmundl <br />-----------------——__________I <br />™n^;HaZeltOnAvenuei Stockton. California 95205 I T 209 468-3420 | F 209 464-0138 I www.sjcehd com <br />oX PW8orn TEMPEVENTAPP <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation- <br />Jessika Best <br />■a <br />Bleach and Water | <br />Q 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 />C] Tub to store wiping cloths in bleach solution. <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 />this event. /I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: 7 <br />SANJOAQUIN <br />-—county— <br />' '''LY' Great oess </rows here. <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 />O Other (specify) _______________________________