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10. <br />11. <br />OR <br />12. <br />er supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />’aper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Health Permit <br />PiH>« Hand ToavIb <br />Soap dilpwosor <br />□teachPfopana Slovc <br />3: <br />Propane 1 <br />Koach iinrl W;Ucr <br />Fire Exthejuisher <br />TEMP EVENT APPPage B of 11 <br />I am providing the following cold temperal <br />45°F (if food is used the following day^rf <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other f^pecify) <br />Slams wCtwffmg <br />fksfi <br />ture control for the cold holding of potentially hazardous foods below <br />laintain below 41 °F temperature); <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />WiBtcwutcr Corfcjirw <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <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 ap/providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Qihree compartment sink. <br />Exira <br />Watw <br />5 20 Gal. <br />Hard wnah Wolnr <br />Sanitizer bucket- <br />Ucodi & waler fol <br />Muring wiping dutlis <br />rxtm ten Bags S- Fvort Containcrz mmt <br />s!or&) fl inrfwa ctf ol the grvutxfl <br />y; <br />Date ■' 1 <br />Rinse Wnkir <br />■■-k, <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHD 16-02 ^0® 8 of 11 <br />0W2W2O23 <br />vrnii j \j r\ v <br />-COUNTV- <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: / <br />Ice Cooler <br />Names of responsible persons to be present in booth during all hours of operation: <br />fd.C. CM C. I (aI* S_____________ <br />“Important** <br />7 <br />Soap and Wawr <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 />thisevent. xi <br />(_ ___________________C) (a A-crz <br />7) Signature Title