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Environmental Health Departmentc <br />10. <br />OR <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />( <br />**important’ <br />Completed by: 14. <br />Signature <br />Paper Hand Tow-els <br />Propone Stwo <br />I <br />PropaonTarA <br />Bteodi sod Wotor <br />Fira EifinguisharQ <br />Ice Cooler J <br />TEMP EVENT APP <br />Extra ten Bag a & Food Contalntrs must <br />stored B Inohm off of th* ground) <br />Stomo w/ChaHing <br />Dish <br />5 Gh> Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal <br />Hand wash Water <br />Sari tew buefei- <br />bteach a water for <br />storing wiping cloths <br />Title <br />I Bleach <br />Soap and Water <br />1868 E Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | VAVW.sjgov.org/ehd <br />EHD wn Page 8 of 11 TEMP EVENT <br />07/01/2024 <br />SAN JOAQUIN <br />------COUNTY------- <br />G''-T/fnei;'i - as i •':” <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 t Ice bath and tubs <br />Other (specify) <br />"TZ <br />Rinse Water <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> Paper towels and pump-style soap container. <br />Harris of responsible persons to be present in booth during all hours of operation: <br /> <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 />Date <br />So»p daporaer ______ <br />| Cutting BoanI j <br />Health Permit p <br />Extra <br />Waler