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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />Completed by: 14. <br />Signature Title Date <br />P*pw Hand Tcwh <br />Prop ana Slow <br />L 11 KJU <br />Soap and Walar Oleach and Water^7 <br />Firs ErtlnouhharG <br />Ice Cooler <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 />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Slerno w/C/umng <br />Oih <br />SaraUzsr bucM- <br />MskTi & waler lor <br />HorWg vdpinQ Uo<h> <br />S Gel Hand wash <br />Weitowiler ConlaViar <br />Water <br />I Propane Tank <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 164)2 Peoa 8 o! 11 TEMP EVENT APP <br />07/3/17 <br />CUbnfl Board <br />I <br />RJnsa Waler <br />[ Beach <br />SAN JOAQUIN <br />COUNTY------ <br />Clll'lll Ill’SS IpOlVS Ill’ll, <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 Q Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).__________________________________________________ <br /> Water supply dispenser with warm water at a minimum of 100’F (l.e. 5-20 gallon container with spigot), <br />t^fone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />iQ/YX. WkvuUjricno_____ _______________________ <br />lam providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Y| 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 />5-20 G«t <br />r- HmdwtihWatir <br />| Soapdipaniar | ---------- \ <br />blrtkiOtgii food Conltlnea mill bt ■ <br />noted a Indiot oil ot the groundl J <br />" I <br />10. <br />| Health Permit ft I