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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />Important*' <br />Completed by:14. <br />Poper Hand Towels <br />Bleach and Waler <br />Fira Extinguishera <br />Ice Cooler <br />TEMP EVENT APPPaga 8 of 11 <br />fl <br />Extra <br />Waler <br />5 Gel Hand wash <br />WaslewatorCcntalnor <br />Garbage <br />Can <br />Sanllirer bucket­ <br />bleach & water (or <br />storing wiping dolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chatflng <br />Dish <br />| 1 Health Permit <br />Title <br />/ <br />Rinse Waler <br />SANJOAOUIN <br />•! ------COUNTY------- <br />«<>v'v ' Great nt’s s yrows here. <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 />S 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. > I n <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 />6-20 Gal. <br />Hand wasli Walor <br />present in booth during all hours of operation: <br />AMiMM______________ <br />aw d <br />Date I ' <br />Propnna Tank <br />“A <br />Soap dispenser ---------- - • <br />| Bleach <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />M Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[xZone separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />1 <br />Soap and Waler <br />10. <br />I Culling Board | <br />Propane Stove _ <br />Name&of responsible persons to b <br />________________________ <br />“Important** 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 />Signature <br />niExtra Ico Bags « Food Conlalncrs must ho <br />stored 8 Inches ott ol the ground! J <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Paga 8 of 11 TEMP EVEN"! <br />07/3/17