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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />ED One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />ED Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />D <br />1 <br />EHD 16-02 <br />07/01/2024 <br />Extra Ice Bags S Food Containers must <br />stored 6 inches off of the ground! <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 />thiseveritAx x rT- f <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/ChaTing <br />Dish <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />I am pjfoviding the following for adequate hand washing facilities, but separate from utensil wash within my <br />bootlr <br />SANJOAOUIN <br />-----COUNTY------ <br />Greotnen growj 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 ED^efrigerator <br /> Refrigerated truck Ice bath and tubs <br />ED Other (specify) <br />1 <br />Soap and Water <br />Propane Tank <br />“Important** <br />Rinse Water <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[J Three compartment sink. <br />0 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 />ED Detergent, bleach, and wiping cloths (cleaning towels). <br />LTlub to store wiping cloths in bleach solution. <br />| Soap dispenser | <br />5-20 Gal <br />Hand wash Water <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />r'‘,r' Page 8 of 11 TEMP EVENT APP <br />Title Date