Laserfiche WebLink
10. <br />11. <br />OR <br />12. <br />Q Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Date <br />Paper Hana "owis <br />Scapcsponscr <br />Ct.f.rtXJ Bai d 3 BleachFrcoane Stow <br />n <br />Propane Tank <br />/Bioacn sac WaterSoap anc Water Rinse water <br />Fire extinqusher <br />■Oi <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[2fWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[Zj One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />DiSJi <br />5 Gal Hand wash <br />YVrrsIc-KatRr Contamwr <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp. <br />Health Permit <br />Sorifizer buckel- <br />Weaeft & waicr iw <br />stodns wipng UcCis <br />[ Extra A <br />Water <br />'Ice Cooler <br />A/rxr— <br />Title <br />vmt j m n v ’ <br />-----COUN~v- <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 rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />Q Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____ Lt i r\ H 6 fk u __________________ <br />_____________ J Ci ri’ <br />**lmportant** <br />SCrs fc» 3uys & Food CotrtHinors must ba <br />stored fi neftw eftot me sn>un</? <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />06/2972023 <br />k <br />y ,-<A C ________________________________________ ____________________________________________________________ <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 />-1 Signature