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Environmental Health Department <br />11. <br />OR <br />12. <br />Q 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 />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />Fire 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 />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Exira fco Bags i Food CoiHaineis must bo <br />stored 6 inchos otfollha gmundi <br />5 Ga! Hand wash <br />Wastewater Contninor <br />Garbage <br />Can <br />Santizcr buexet- <br />bteech 8 waler for <br />storing wiping dolbs <br />10. <br />Stemow/Chaffng <br />Dish <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.sjcehd com <br />OT/Sn'02 Pago 8 of 11 TEMP EVENT APP <br />fC Booth must be on <br />| / Concrete, Asphalt, <br />’ Plywood, or a Tarp. <br />'--------------- ----------' <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />—d <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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Tub to store wiping cloths in bleach solution. <br />| Soap dispenser <br />- fl <br />^arn^providing the following for adequate hand v/ashing facilities, but separate from utensil wash within my <br />^W^SANdOAQUIN <br />------COUNTY------ <br />Grenlness </roivs /lere. <br />I am providing (he 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 4rF temperature): <br />S Ice chests Refrigerator <br /> Refrigerated truck 0 Ice bath and tubs <br />O Other (specify) <br />Boun Ouk & Emily Ouk <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 />Sole Business Owner 4/4/2025 <br />Title Date <br />Soap end Water Rinse Water <br />Exira <br />Water