Laserfiche WebLink
Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />Completed by. 14.DateuTitle <br />Health Permit <br />'1 Paper Hand Twels <br />I Culling Doaid | <br />Bleacli <br />Propane Slovo <br />IL <br />filnach and Wainr <br />G <br />Ice Cooler <br />TEMP EVENT APPPage fl of 11 <br />Slamo wKbalfmo <br />Dish <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or o Tarp. <br />S Gel Hand wash <br />WasloWSlorConlalner <br />Sanhizer bucket- <br />Hench S water tor <br />storing vriping cloths <br />6-20 Gat <br />Hand wash Water <br />( Extra \ <br />Waler <br />SANJOAQUIN <br />-----COUNTY------- <br />(jri'olric.s t/:.-:v.s Inrrc. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />DnnA ft nf *11 • uvuti iEHD 16-02 Page fl or 11 <br />07/3/17 <br />[ PropanaTank I <br />Soap dlipansor 1 ---------- <br />' U-... <br />'••if J.- '’ <br />I am ,--------o--------- ----„ — <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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[~| Three compartment sink. <br />^Jhree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />*^lution (one tablespoon of bleach per gallon of water). <br />^Detergent, bleach, and wiping cloths (cleaning towels). <br />Spfub 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 />l^A/Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Jg'One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />J^'Paper towels and pump-style soap container. <br />Names of responsible personate be present in bootl^d^^ all^hours of operation. <br /> <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 /> <br />Signature Q Title <br />EXIra Ice DoQt K Food CoiMncn must l>o <br />stored 6 Inches oil ortho otoundl