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Environmental Health Department <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 />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />Completed by:14. <br />Signal <br />Papor Hki>U Tmvsh <br />I Culling Board I <br />Propane Stove <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />□ Ice chests <br />□ Refrigerated truck <br />53 Other (specify)__ <br />SlemovrfCha fling <br />Olsn <br />Garbage <br />Can <br />Sanliizorbuckot- <br />ttoach & water for <br />storing wiping dolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />All fo< <br />prep; <br />prepl <br />thi <br />6 Go! Hand wash <br />Wastewater ContainerExira Ice Bags S Food Cantalne/s must bo <br />stored 6 Inches oH oTUie groundl <br />__S' <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjcehd.com <br />Dane R rJ 11 • EMr EVElN IEHD 16-02 Pages oi 11 <br />07/3/17 <br />■C-’4)FrR^’ <br />10. <br />] Propane Tank Beech and Water | <br />j Soap cSspanser <br />| Health Permit <br />□ Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />UJAyWE' _______________ <br />“Important** <br />Ck-fC- SV<^b\<L. <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />i vendor booths are subject to inspection. Please make a copy of this application in <br />ition for this event. A copy of this checklist must be in the booth at all hours of <br />iratipn and opkratidih. Return original to festival coordinator three weeks prior to <br />I/1 3 -il'M <br />Title Date <br />5-20 Gal <br />y Hand wash Water <br />I K <br />/--- \ •': • j <br />Soap and Water <br />SANJOAQUIN <br />V’1 -----COUNT Y------ <br />Greatness grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (rf food is used the following day, maintain below 41 °F temperature): <br />□ Refrigerator <br />□ Ice bath and tubs <br />All for)' <br />:-- <br />Rinse Water