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S A N MOM M Environmental Health Department <br /> C. OU NTY <br /> t 5,, Greatness grows here. <br /> 10. 1 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 /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑ Three compartment sink. <br /> OR <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 /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth.- <br /> Water <br /> ooth:Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> ,M&t&t i-M <br /> ® One separate4tib(bucket or bash,)-for the collection of rinse/wastewater. <br /> ® Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> pI,AN FP.Ef�MptJ (/w) - (034 <br /> s eau FpN�e�cK (_7i09 Zto ^ �3�Z <br /> "*Important" 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 /> thi ent. <br /> 14. Completed by: <br /> Signature Title Date <br /> 5-20 Gal <br /> Health Permit Hand wash Water <br /> Sterno wlChaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser uc <br /> Cutting Board Sanitize,bket- <br /> bleach&water for <br /> Propane Stove <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> 0 Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> i <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> stored 6 inches orf of the ground! <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com <br />