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Environmental Health Department <br />11. <br />OR <br />12. <br />0 Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />‘‘important** <br />Completed by:14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />I <br />Propane T ank <br />Fire ExtinguisherQ <br />Ice Cooler <br />Q 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 />Extra Ico Hags & Food Containers must bo <br />stored 6 inches otto! the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Santtizor bucket­ <br />bleach 8 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chairng <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />I <br />Soap and Water <br />zz. <br />Rinse Waler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <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. <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pago 8 of 11 TEMP EVENT APP <br />07/3/17 <br />IO <br />,.b.—. V <br />— I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />ZdZz SAN JOAQUIN <br />- SI KZ ----C O u N T Y----- <br />' Grea In ess j/rows Aere. <br />10. 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 />O Ice chests [x] Refrigerator <br />□ Refrigerated truck ® Ice bath and tubs <br />□ Other (specify)_ ______________________ <br />Amber Synha Director of Catering & Events 2/19/26 <br />Title Date