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Environmental! Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Cuttina Board <br />BleachPropane Stove <br />u• i. <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisherfl <br />TEMP EVENT APP <br />fl <br />-----71 <br />Soap and Waler <br />ELK^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Qd^aper towels and pump-style soap container. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Extra Ice Bags S Food Containers must be <br />stored 6 inches ott of the groundl <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitijer bucket­ <br />bleach 4 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Q^A/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Slemo w/Chatfmg <br />Dish <br />5-20 Gol. <br />Hand wash Water <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 />Quetergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Ice Cooler <br />_z <br />Rinsa Water <br />SANJOAOUIN <br />r. J ? -----COUNTY------- <br />■-J-pfl., Ci,-vi nc $ s gcoivs ill re. <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 />[^ce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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. / / v n, z~ / a /t...... s/K I -3 <br />Title Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TC.-.-.." C. <br />07/3/17 <br />Names of responsible persons to be present in booth during all hours of operation: <br />“Important** <br />| Soip ditpenief [ ---------- <br />1q