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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important’* <br />14. <br />Signature <br />Papar Hand Tcw»ls <br />Culling Heard <br />Propane Stove <br />r <br />Fire Extinguisher <br />Ice Cooler <br />07/3/17 <br /> <br />5 Gal Hand wash <br />Wastcwatar Container <br />Garbage <br />Can <br />Boolh must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />6-20 G01. <br />Hand wash Waler <br />Sanitizer bucttei- Pieach 2 water for <br />storing wiping cloths <br />Slcmo wfChafiing <br />Dish <br />SAN JOAQUIN <br />-----COUNTY------- <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e, 5-20 gallon container with spigot). <br />J^)ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Health Permit <br />Title <br />Extra tee flags S Food Confa'ners must ba <br />slored 6 inches ofl ol the ground! | <br />Rinse Waler <br />Propane Tank <br />Bleach and Water <br />, .... •' :. •. C ! [' •; j h. •.?f?. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br />I^Wce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_________ _____________________________________ <br />JL. <br />Soap and Waler <br />Al! 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 ------------------ OLiy/UC/' 3 <br />bate <br />i am^providing the following for adequate hand washing facilities, but separate from utensil wash within my <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 Soap dispenser | ---------- <br />Names of responsible persons to be present in booth during all hours of operation: <br />/y/p 7T (3^^ •</ r IZ /'J /3c. r ____________ <br />Hazellor'Avenue 1 Stocklon- California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjcehd.com <br />Page 8 of 11 TEMP EVENT APP <br />Extra <br />Water