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Environmental Health Department <br />11. <br />OR <br />12. <br />E3 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 />S Paper towels and pump-style soap container. <br />13. <br />‘important** <br />owner14.Completed by: <br />Title <br />Paper Hand Towels <br />Soap dispenser <br />Propane Siove <br />Lhi <br />I PropaneTank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Pag« 8 of il <br />Health Permit <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5 Ga! Hand wash <br />Wastewater Container <br />Garbage <br />Can” <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />EHD 16-02 <br />07/3/17 <br />Stemow/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Extra <br />Water <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />1 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 />All food vendor booths are subject to inspection. Piease 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 />of -5-13-^ <br />Signature Title Date <br />Ex/za leb Bags & Food Containers must be ? <br />stored 6 inches oil ot the ground! <br />Sanilizerbucke:- <br />bleach&walorfsr <br />storing v/lping clothsdu± <br />Rinse Waler <br />I Culling Board <br />r=5 <br />Soap nnd Water <br />Q <br />10. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Ursula Kemp-Paden, Marlon Paden and Makenzie Paden <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 Bleach (L <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 [ F 209 464-0138 | www.sjcehd.com <br />CHD1CC2 Pagnsofil TEMP EVENT APR