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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and oump-style soap container. <br />13. <br />Date / <br />14. <br />Health Permit N <br />PaporHand Towels <br />Cutting Board 3Propane Stove <br />u <br />Propane Tank <br />Bleoch and Watar <br />Fira Extinguisher <br />Ice Cooler <br />Stemow/Cha fling <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gel. <br />Handwash Water <br />Sanitizer buckot- <br />bloach e water for <br />storing wiping cloths <br />SAN JOAQUIN <br />- COUNTY------ <br />( £xva \ <br />Water <br />Names of re^^c^stole pt^o^^ejopesent in booth during al! hours of operation: <br />Title <br /> Water supply dispenser with warm water at a minimum of 1 GOT (i.e. 5-20 gallon container with spigot). <br />Rinse Water <br />“Important** <br />^arr^providing the follov/ing for adequate hand washing facilities, but separate from utensil wash within my <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 />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 />Completed <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Exira fa> flags S Food Confaroers mosl bo <br />stored 6 Lnchss ott ot the groundt <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 />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | wvjw.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />Soap dispenser I ---------- ' <br />I aMCh k <br />7 <br />Soap a nd Waier