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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Health Permit p <br />Paper Hand Towels <br />Propane Stove <br />X< I h7] <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 <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 <br />this event. / <br />5 Gal Hand wash <br />Wastewater Contafr.ar <br />Garbage <br />Can <br />Sanitizer bucket- <br />Keach a water fcr <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Extra <br />Water <br />5-20 Gal. <br />Harxi wash Water <br />Sternow/Cha fling <br />Dish <br />Propane Tank <br />-MO <br />Title <br />Soap and Water <br />zzz <br />Rinse Water <br />Exlre Ice Bags & Food Containers must bs J <br />stored 6 inches off of the ground! <br />iZtZ <br />10. <br />SANJOAQUIN <br />■ Z ------COUNTY------- <br />Greotness grows here. <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 />L3 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Cutting Board | <br />Names of responsible persons to t^prepent in booth during all hours of operation: <br />“Important** 7"‘ ’ 7' ' .............. ' ~ <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />| Soap dispenser | \ <br />I Blea;n k <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I VAwy.sjcehd.com <br />07/3/lT°2 Page 8 of 11 TEMP EVENT APP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />H Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 £>rie separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />i operation. Return original to festival coordinator three weeks prior to <br />Signature Title Date! '