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Envoroonm^n^B Health Deipartmsmt <br />OK <br />12. . <br />13. <br />^Important** <br />Completed by: 14. <br />Signature <br />Paper Hand rowels <br />Propane Slow <br />IW <br />Blenoli and Waler <br />Fire EMIngalshcr <br />Ice Cooler <br />TEMP EVENT APP <br />Garbage <br />Can <br />SenilizcrbiKkol- <br />hleacli & waler Tor <br />slodno wlplnu ctollis <br />Boolh must be on <br /> Concrete. Asphalt, <br />Plywood, ora Tarp. <br />10. <br /> Stemow/ChaWIno <br />Olah <br />5 Gal Hand wash <br />Waslcwalcr Container <br />co Ct <br />Title <br /> 5-20 Gal. <br />Hand wash Wulnr <br />jmPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of opo^ation: <br />washing facilities, but separate from utensil wash within my <br />I PrcpaooTnnk <br />RlnsoVWlar <br />[ Edra \ <br />Wnler <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />lass___________________ <br />I Istlta Ice Begs S l oad Cvnlww bo Ij <br />stotodn Mies olf ollho groundl ;d <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 464-0138 | www.sjcehd.com <br />EH01B-02 Page 8 of 11 TEMP EVENT <br />07/3/17 <br />All food vendor booths aro subject to Inspection. Pleaso make a copy of this application In <br />preparation for this event. A copy of thts checklist must be in the boolh al all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />Date <br />SAIWOAQUIN <br />5” J ------COUNTY------- <br />t-.reolness grows hf?re. <br />1 am providing tho following cold temperature control for the cold holding of potentially hazardous foods below <br />4/?F (if food is used the following day, maintain below 41 °F temperature): <br /> Ico chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).____________________________________ <br /> Three deep tubs (basins 6-8 Inches minimum), ono 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 <br />booth: <br />^Water supply dispenser witti warm water at a minimum of lOO’F (i.e. 5-20 gallon container with spigot). <br />-IgfOno separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Soap dispenser |----------, <br />| aeicf? j <br />SoapnndWalef <br />r <br />| Gimlnq Board j