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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 />13. <br />“Important** <br />Completed by:14. <br />| Health Permit <br />Paper Hand T owels <br />Soap dispense' <br />RleacnPropane Slove <br />It L <br />Bleacn and A atorRinse Water <br />Fire Enuxjuisnera <br />P<)ne separate tub (bucket or basin) for the collection of nnse/wastewater. <br />Q^aper towels and pump-style soap container. <br />Sterno w/Cnaffing <br />Dtsh <br />5 Gal Hand wasn <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucset- <br />bleacn & water lor <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gal <br />Hand wash Water <br />Title <br />SAN JOAQUIN <br />C O U N T Y <br />Date <br />I <br />Soap and Waler <br />Propane Tats* <br />Ice Cooler <br />I am 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 nnsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />0Oetergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 />_____C fTu 0 <br />T Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 TEMP EVENT APP <br />07/3/17 <br />tra ice Bags 4 FooO Containers must Oe K <br />stored 6 incites ott ot the ground' j <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 />Q Ice chests ® Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _—-— -----------------—------------------------------------------- <br />Names of responsible persons to be present in booth during all hours of operation: <br />_______Phil or _______________