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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 /> Paper towels and pump-style soap container. <br />13. <br />**Importa nt** <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Culling Board <br />Propane Suwe <br />It <br />Propane Tank <br />Bleach and Waler <br />Are ExUcgjisherfl <br />Ice Cooler <br />EHD 16-02 <br />07/3/17 <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 />Names of responsible persons to be present in booth during all hours of operation: <br />Norma Muhlenbruch & David Muhlenbruch <br />Extra Ice Bags & Food Conlolners must be <br />stored 6 Inches olt o! the ground) <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 />Stamo w/Chatnng <br />Dish <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 G< <br />Hand wash Waler <br />Garbage <br />Can <br />Sanitizer bucket- <br />blcach & water for <br />storing wiping cloths <br />IE <br />Rinse Water <br />Soap dispenser '"J <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />=-=2 Page 8 of 11 TEMP EVENT APP <br />10. <br />jt’LJ <br />Soap and Water <br />SANJOAQUIN <br />-----COUNTY------ <br />Greotness tjrows 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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />0 Other (specify) Eelectric coolers powered by jackeries