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Environmental Health DepartmentS4N JOAQUIN <br />10. <br />11. <br />OR <br />12. <br />5-20 gallon container with spigot). <br />13. <br />Important** <br />Completed by.14. <br />Health Permit <br />Paper Hand Towels <br />Soap aipenser <br />Ctiling Board <br />Bleach <br />Propane Stove <br />2 <br />Propane! arm <br />Fire E»t.ngu.»her <br />Ice Cooler <br />TEMP EVENT APP <br />Slirmo wlClwIfing <br />□tsh <br />5 Gal Hand wash <br />Watle»'3ler Ccnla.ne' <br />Garbage <br />Can <br />Sanitizer buckffl- <br />Heach & water for <br />stonng wiping doths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Title <br />r <br />Soap and W«er <br />7 <br />Pm*e Water <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 Jo <br />thisevy^^^ ------------ <br />r Signature T,tle Date <br />Extra lc« Bags 4 Food Containers must De | <br />sfcxod fl mc/»s at! ol the gmund' » <br />1868 E. Hazelton Avenue | Stockton. Califom.a 95205 | T 209 468-3420 1 F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 <br />07/3/17 <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 0-Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__------------------------------------------------------------------------ <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />g) 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 /> Water supply dispenser with warm water at a minimum of 100°F (i.e. <br />P<)ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Phi I or CrxfSfcJ* MHk/,—-------------------